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vv. r^a//4 ; fl4 ^ 



94th Congress 
2d Session 



COMMITTEE PRINT 



U.S. DEVELOPMENT AID PROGRAMS IN 
WEST AFRICA 

I. Population Planning Activities 
II. The Senegal River Basin Projects*^ 
III. Reimbursable Development in Nigeria 



REPORT 

OF A 

STAFF SURVEY MI 





MARCH 22, 197G 



Printed for the use of the Committee on International Relations 



06-331 



U.S. GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1976 






COMMITTEE ON INTERNATIONAL RELATIONS 

THOMAS E. MORGAN, Pennsylvania, Chairman 



CLEMENT J. ZABLOCKI, Wisconsin 
WAYNE L. HAYS, Ohio 
L. H. FOUNTAIN, North Carolina 
DANTE B. FASCELL, Florida 
CHARLES C. DIGGS, JR., Michigan 
ROBERT N. C. NIX. Pennsylvania 
DONALD M. FRASER, Minnesota 
BENJAMIN s. ROSENTHAL, New York 
LEE II. HAMILTON, Indiana 
LESTER L. WOLFF. New York 
JONATHAN 15. BINGHAM, New York 
CAS YATRON, Pennsylvania 
BOY A. TAYLOR. North Carolina 
MICHAEL HARRINGTON, Massachusetts 

LEO J. RYAN. California 
DONALD W. RIEGLE, Jr., Michigan 
CARDISS COLLINS. Illinois 
STEPHEN .1. SOLARZ; New York 
HELEN S. MEYNER, New Jen 
DON BONKER, Washington 
GARRY E. STDDDS, Massachusetts 



WILLIAM S. BROOMFIELD. Michigan 
EDWARD J. DERWINSKI, Illinois 
PAUL FINDLEY, Illinois 
JOHN II. BUCHANAN, .Ik.. Alabama 
.1. HERBERT BURKE, Florida 
PIERRE S. Di- PONT. Delawan 
CHARLES W. WHALEN, .In.. <>hio 
EDWARD G. BIESTER, .lit.. Pennsylvani 
LARRY WINN, JR., Kansas 
BENJAMIN A. OILMAN, New York 
TENNYSON GUYER, Ohio 
ROBERT .1. LAGOMARSINO, California 



Marian a. Czarnecki, chief of Staff 
Sandra p. Reinhardt, Staff Assistant 



Sub< oM mi i i 1 1: on Oversight 

THOMAS E. MORGAN, Pennsylvania, Chairman 
CLEMENT .1. ZABLOCKI, Wisconsin WILLIAM s. BROOMFIELD, Michigan 



WAYNE L. HAYS, Ohio 

LEO J. RYAN, California 

i I Ll. I.N s. MEYNER, N.u Jersey 



EDWARD -I. DERWINSKI, Illinois 



Si \i r Si i:\ Bl TE \m 



John h. Sullivan, Senior staff consultant 
i i pmah Chester, Staff consultant 



(ID 



FOREWORD 



House; of Representatives, 
Committee ox International Relations, 

Washington, D.C., March 22, 1976. 
This report has been prepared for the committee by a staff survey 
team comprised of John H. Sullivan and John Chapman Chester, 
staff consultants to the Committee on International Relations. 

The findings contained in this report are those of the staff survey 
team and do not necessarily reflect the views of the members of the 
Committee on International Relations. 



Thomas E. Morgan, Chairman. 



(in) 



Digitized by the Internet Archive 
in 2013 



http://archive.org/details/usdntaidOOunit 



LETTER OF TRANSMITTAL 

March 22, 1976. 
Hon. Thomas E. Morgan, 

Chairman, Committee on International Relations, House of Repre- 
sentatives. Washington, B.C. 

Dear Mr. Chairman : There is transmitted herewith a report of a 
staff survey team composed of the undersigned staff consultants. Com- 
mittee on International Relations, which visited sites in West Africa 
between November 28 and December 18. 

One purpose of our review — and the subject of this report — was to 
evaluate several aspects of U.S. development assistance programs in 
West Africa. They included: (a) population/family planning pro- 
grams, (b) the Senegal River Basin project, and (c) reimbursable 
development programs in Nigeria. 

Our assignment also included an evaluation of Peace Corps opera- 
tions in the countries we visited. That report has been submitted under 
the title, "The Peace Corps in West Africa. 1975/' 

During the course of our mission we visited Sierra Leone, Ivory 
Coast, Upper Volta, Ghana, Xigeria, and Senegal. We also made a 
stop in London to meet with officials of the International Planned 
Parenthood Federation (IPPF). As part of our mission, we met 
with U.S. Embassy officials. Agency for International Development 
(AID) Mission personnel. Peace Corps staff and volunteers, in addi- 
tion to numerous host government officials, representatives of interna- 
tional organizations and concerned private citizens. All received us 
with courtesy and contributed significantly to our understanding of 
of the matters under review. 

In each country. AID Mission personnel, in conjunction with the 
U.S. Embassy, arranged a full schedule of meetings, field inspection 
trips, and other activities. We are grateful for their assistance. 

The results of our investigations were also enhanced by briefings 
and meetings held in Washington, both before and after the mission, 
with officials of AID and the Department of State. 

It is our hope that the information contained in this report will be 
helpful to members of the committee and to the Congress in future 
deliberations on relevant L^.S. development aid programs. 

John IT. Sullivan, 

Senior Staff Consultant. 
John Chapman Chester, 

Staff Consultant. 

(V) 



CONTENTS 



Page 

Foreword in 

Letter of transmittal v 

I. Population planning activities: 

A. Summary of findings 1 

B. Population planning in Africa 3 

C. Nigeria 7 

1. The Nigerian Government and population planning-. 8 

2. Population assistance to Nigeria 8 

3. U.S. bilateral aid: The Family Health Training 

Program 9 

4. The Family Planning Council of Nigeria (FPCN) 11 

5. Summary and comment 12 

D. Ghana 1 13 

1 . Ghana and population planning 13 

2. Population assistance to Ghana 14 

3. Direct AID bilateral programs 16 

4. The Danfa project 17 

5. Planned Parenthood Association of Ghana 18 

6. Summary and comment 18 

E. Sierra Leone 19 

1. U.S. -related population assistance 20 

2. The Sierra Leone Family Planning Association 

fSLFPA) 20 

3. Summary and comment 21 

F. Ivory Coast ■ 22 

1 . Population views of government 22 

2. Summary and comment 23 

G. Upper Volta 24 

1. AID's "Population Action Agenda" for L^pper Volta___ 24 

2. Two projects reviewed 25 

3. Summary and comment 25 

H. Senegal 1 2G 

1. The Croix Bleue Clinic 26 

2. Senegal rural health services development program 27 

3. Summary and comment 27 

I. International Planned Parenthood Federation (IPPF) 28 

1 . Criticism of IPPF operations 29 

2. Discussions with IPPF official :'. 1 

3. IPPF in West Africa 31 

4. Summary and comment 32 

II. Senegal River Basin Project: 

A. Summary of findings 33 

B. The problem of the Sahel 34 

C. Long-term development of the Sahel 37 

D. Congressional action 39 

E. The Senegal River Basin Project 40 

F. United States assistance to OMVS 43 

G. Assessment of the project 44 

H. Conclusion and comment 4 i 

(VII) 



VIII 

III. Reimbursable development programs in Nigeria: Page 

A. Summary of findings 49 

B. Background of program 49 

C. Nigeria as AID "graduate" 50 

D. Nigerian economic planning 51 

E. Role of the United States 52 

1. The block grant 53 

2. Facilitative services 54 

F. Reimbursable development programs 54 

1 . The technical assistance package 54 

2. Discussions with the ministries 55 

G. Staffing. oo 



I. POPULATION PLANNING ACTIVITIES 



A. SUMMARY OF FINDINGS 

1. Despite the clear requirement for most nations in West Africa 
to curb high population growth rates if economic development 
is to be facilitated, little or nothing is being done in the countries 
we visited. A single exception is Ghana where a national policy 
of population planning has picked up momentum in recent months 
but still is hampered by bureaucratic squabbling. 

2. As previous committee staff surveys have found, 1 a prin- 
cipal stumbling block to population planning efforts is the lack 
of interest — and sometimes outright hostility — on the part of 
government leaders. Their attitudes are formed by: (a) tradi- 
tional pronatalist ideas; (b) religious objections; (c) fears of 
larger neighbors or of rival tribes within a country; and (d) 
identification of large populations as necessary to national 
development. 

3. Population growth rates in most of these countries actually 
appear to be on the increase as infant mortality falls because of 
improved immunization programs against smallpox, measles, 
and malaria, and because of belter education in nutrition. 

4. The integration of family planning with health services, 
particularly maternal and child health, is a requirement for 
progress in the African context. To the extent that the United 
States has not been identified with such a strategy in the past, 
our offers of assistance may be viewed with suspicion by 
governments. Both U.S. officials and African nationals inter- 
ested in population planning agree that the new language in U.S. 
foreign assistance legislation emphasizing integrated programs 
should help their efforts at promoting "family spacing" within 
a context of family health. 

5. The attitudes of West African political leaders toward popu- 
lation planning efforts might well be changed if there were the 
same enthusiastic response in local communities as there is to 
other government services, such as schools, medical facilities, and 
feeder roads. Such enthusiasm might be generated by providing 
family planning as part of comprehensive maternal and child 
health services. 



l U.S. Aid to Population/Family Planning in Asia, report of a staff survey team to the 
or m ?!!io ee on Forei " n Affairs. U.S. House of Representatives (93d Cong., 1st sess 1. Feb 
-;> .'•»<■*. and "New Directions" in Development Assistance: Implementation in Four 
J.atin American Countries, report of a staff survey mission to Colombia, Bolivia, Guate- 
mala, and the Dominican Republic, Committee on International Relations (04th Cong., 
1st sess.), Aug. 31, 1975 

(1) 
GG-331— 7G 2 



6. Data being developed in Ghana indicate that contraception 
continuation rates are highest when family planning is inte- 
grated into health programs. As a result, integrated systems 
also may be the most cost-effective way of providing population 
services. 

7. Because the receptivity of poor people to population planning 
appears to hinge on lowering rates of infant mortality, improved 
mother/child health and nutrition are essential to fertility con- 
trol. Therefore, legislation which would deny Public Law 480 
food and economic assistance to countries with high birth rates 
would be self-defeating. 

8. In view of management difficulties, and possible violations 
of restrictions in the Foreign Assistance Act, the nature of U.S. 
aid to the International Planned Parenthood Federation — IPPF — 
should be altered to permit better monitoring by AID of IPPF's 
use of funds. 



B. POPULATION PLANNING IN AFRICA 

Unlike Asia which we visited in 1972 on a similar study, the entire 
issue of population growth has scarcely been addressed by most of the 
countries of Africa. Population funds going to Africa from the 
Agency for International Development generally have been con- 
siderably smaller than such funds going to Asia. Latin America, and 
the Near East/South Asia region. 

At the same time, AID has been increasingly interested in popula- 
tion/health programs for Africa. From a $13.7 million program for 
the entire continent in fiscal year 1976. the agency plans an increase 
to S25.5 million in fiscal year 1977. 

Our objective was to assess the opportunities, challenges and ob- 
stacles to the introduction of effective family planning/population 
control programs into the African environment. Of particular interest 
was the applicability in the West African countries we visited of new 
policy language adopted by the Congress in 1975 as part of the Inter- 
national Development and Food Assistance Act of 1975 (Public Law 
94-161) . That language says : 

Assistance provided under this section 1 shall be used pri- 
marily for extension of low-cost, integrated delivery systems 
to provide health and family planning services, especially to 
rural areas and to the poorest economic sectors, using; para- 
medical and auxiliary medical personnel, clinics and health 
posts, commercial distribution systems, and other modes of 
community outreach ; health programs which emphasize 
disease prevention, environmental sanitation, and health edu- 
cation: and population planning programs which include 
education in responsible parenthood and motivational pro- 
grams, as well as delivery of family planning services and 
which are coordinated with programs aimed at reducing the 
infant mortality rate, providing better nutrition to pregnant 
women and infants, and raising the standard of living of the 
poor. 

Africa is the least developed of the world's continents. Rudimentary 
services and facilities which may be available to the people of less- 
developed countries in Asia and Latin America often are absent from 
African nations. 

Most Afrieans do not have access to even the simplest kind of medi- 
cine or disease control. As a result, as a region, Africa has the world's 
highest death rates, and shortest life expectancy. Statistics tell the 
story : 

1 Section 104 (Population planning and health) of the Foreign Assistance Act of 1961, 
as amended. 

(3) 





Africa 


United States 


Infant mortality (per 1,000 births) 


161 


16.5 


Life expectancy (, ears) 


44 


71 


People per physician 


14, 000 


600 









Africa as a region also has the highest birth rales in the world. 
Despite its high mortality, health problems, and decreasing per capita 
food production, the population of the continent increases at an esti- 
mated 2.6 percent a year. 

Most African countries have made little or no effort to develop sig- 
nificant family planning programs. In part, the perception of high 
infant deaths results in pronatalist attitudes or a lack of interest in 
population planning. 

in every West African country we visited, the idea of population 
planning is, in varying degrees, a sensitive subject to political leaders. 
Among I he factors which make it so are : 

ligion. — Throughout West Africa the dominant religious be- 
lief is Islam. The Moslem sects tend to be conservative and tradi- 
tional, with pronatalist and anticontraceptive attitudes. In former 
French colonies like' Ivory Coast and Senegal, important national 
leaders are Roman Catholics who reflect that church's traditional 
views on family planning. 

Tribal rivalries. — Tn a number of African states the political 
structure is a reflection of tribal interests. In such situations, 
groups attempt to maximize their population in order to obtain 
or increase political dominance. Xio-eria is a recognized example 
of this condition, but other nations have a similar problem. 

National development. — The idea is current in many African 
countries that large populations are essential to national eco- 
nomic growth and progress. Thus, leaders in the Ivory Coast will 
espouse a population several times the country's present size as 
an ideal to be reached as part of the economic development 
process. 
Although Africa's infant mortality rates remain high, they have 
declined by up to 50 percent in the Inst 25 years. The result has been 
increases in family size with attendant problems. 

There was a strong consensus among African population specialists 
with whom we spoke that family planning services can best be ad- 
vanced in Africa by integrating them into programs of health, par- 
ticularly maternal and child health (MCH), and nutrition. The 
re sei era! : 
The only way which family planning programs are likely to 
be palatable i<> \ frican leaders is by present ing them in a health 
context. Instruction in "child spacing" may be acceptable as 
part of an MCH program in count ries where "family planning'' 
and "populat ion cont rol" arc not. 

I imitation of family size will improve the total health of a 
population. Programs designed to curb family size can have 
itive health imparl not only on the mother but the entire 
family. For example, children in large families tend to have 
more nutritional deficiencies. 



— Health services, which are in demand throughout Africa, can 
provide an excellent vehicle for providing family planning. By 
expanding a complementary set of family planning services as 
an integral part of basic health delivery systems, it is argued, 
the potential health hazards of certain family planning meth- 
ods can be minimized, and, at the same time, the motiviation 
for using the services can be enhanced. 
— The demand for health services can be a means of overcoming 
official opposition to, or neglect of. population planning pro- 
grams. The lack of strong community enthusiasm for the rue- 
vision of family planning services permits leaders their apathy. 
If the same eagerness which Africans have for new schools, 
clinics and roads could be marshaled, changes would come. 
Comprehensive maternal and child health services likely would 
be greeted with enthusiasm. Providing such services, with a 
family planning component, could help energize national 
authorities. 
■ — Evidence from the Danfa Project in Ghana, the most rigorous 
study of the health/family planning relationship in Africa, is 
that contraceptive continuation rates are highest when the serv- 
ice is provided within a total health context. Further, it may 
be the most cost-effective way to proceed. (See pp. 17-18.) 
Many United States and African population specialists with whom 
we spoke believed that a positive step had been taken by Congress in 
adopting new policy language in the International Development and 
Food Assistance Act of 1975 (Public Law 94-161). That language 
which emphasizes integrated programs, amends the section of the 
Foreign Assistance Act under which health and family planning pro- 
grams are funded. It states : 

Assistance provided under this section shall be used pri- 
marily for extension of low-cost, integrated delivery systems 
to provide health and family planning services, especially to 
rural areas and to the poorest economic sectors, using para- 
medical and auxiliary medical personnel, clinics and health 
posts, commercial distribution systems, and other modes of 
community outreach; health programs which emphasize di- 
sease prevention, environmental sanitation, and health educa- 
tion in responsible parenthood and motivational programs, 
as well as delivery of family planning services and which are 
coordinated with programs aimed at reducing the infant mor- 
tality rate, providing better nutrition to pregnant women and 
infants, and raising the standard of living of the poor. 

The extent to which the United States is identified with such a pol- 
icy and carries it into practice, we were told, is likely to determine its 
success in gaining the cooperation of African governments for popu- 
lation planning purposes. 

In our discussions we also explored the question of the potential im- 
pact in Africa of pending legislation which would cut oil' development 
assistance and food aid to those countries which do not immediately 
embark on vigorous family planning efforts to bring down their popu- 
lation growth rates and meet certain target reductions. Without ex- 



ception, our respondents saw such legislation as impractical, impolitic, 
and — both in the short and long term — more likely to harm the cause 
of world population control than to advance it. 

Among the reasons cited against such a legislative effort were the 
following: 

— Such legislation would reverse current U.S. policy as set forth 
in title X of the Foreign Assistance Act. Title X states that, 
"every nation is and should be free to determine its own policies 
and procedures with respect to problems of population growth." 
— Allegations of cultural interference and even genocide have 4 
been leveled at U.S. family planning/population control pro- 
grams in the past by foreign antagonists. A program which 
tied food aid to population control measures would certainly 
he seen abroad, particularly in Africa, as racially motivated and 
an unwarranted infringement of sovereignty. 
— Particularly in Africa, population remains a sensitive domestic 
political issue. A blatant "carrot and stick" approach to the 
problem by the United States would entangle the issue with 
national pride and could cause even those countries with on- 
going population programs to terminate externa] participation. 
— Many specialists believe that ultimate population stabilization 
cannot occur while infant mortality is still so high in devel- 
oping African countries. Parents have more children than they 
really want in order to insure the survival of some into adult- 
hood' who can then, in turn, care for their aging parents. The key 
to lower infant mortality rates is improved nutrition for young- 
sters — a prime objective of the Public Paw 480 program. Cut- 
ting off nutrition programs because a country refused to initiate 
family planning programs, would, therefore, be counterpro- 
ductive. 
—Several respondents noted that population statistics are notori- 
ously inaccurate in Africa. To base grants of foreign assistance 
on such estimates is to invite manipulation of the data rather 
than effective action to control loo-rapid population growth. 
The U.S. effort should be toward gathering accurate informa- 
tion, regardless of how alarming it may be. rather than encour- 
nir chicanery. 
— If, as many demographers believe, death rates must decline be- 
fore birth rates will, a rising population growth rate during the 
transition period is virtually inevitable. In Africa, where death 
rates are si ill very high but declining.au incTi a&< in population 
growth rates may be (expected in some countries over the next 
few years. To make foreign aid contingent on declines in pres- 
ent population growth rates would appear i>> ignore demo- 
graphic realities. 



C. NIGERIA 

Demographic Estimates 

Population (1975) (million) 70_8 9 

Density (persons per square mile) 225 

Birth rate (per 1000 population) 50 

Death rate (per 1000 population) 23 

Annual growth rate 1970-75 (percent) 3.2 

Infant mortality (per 1000 live births) 157 

Life expectancy (years) 40 

Years to double population based on current rates of growth 24 

Xigeria is located on the west coast of Africa, bounded on the south 
by the Gulf of Guinea and landward by Cameroon, Chad, Niger 
and Benin (Dahomey). The most populous country in Africa, with 
21 percent of the continent's population, Xigeria is about the size of 
California, Nevada and Arizona combined. 

Xigeria is also one of Africa's richest countries with a gross national 
product (1974) of $18 billion and an annual growth rate of 10 per- 
cent. Sparked by large petroleum profits which provide most gov- 
ernment revenue and foreign exchange earnings, national production 
and income have risen sharply. 

At the same time, however, the vast majority of the population is 
poor. Per capita GXP is $285 annually. The literacy rate is about 
25 percent. Nigeria's urban slums are among the worst to be seen 
in Africa. 

Of the six countries we visited, Xigeria is the one in which exces- 
sive population and crowding is most evident. Its countrywide popula- 
tion densities are 10 times those of Upper Volta, 4 times those of 
Senegal and Ivory Coast, and about twice those of Sierra Leone 
and Ghana. 

While demographic statistics on Xigeria are notoriously unreliable, 
many observers believe that the figure of 80 million reported in the 
1973 census is not far from the mark. At that figure, Nigeria is the 
ninth most populous country in the world and sixth among develop- 
ing nations. 

If Nigeria's present rate of population growth, one of the world's 
highest, is maintained, its population will double by the end of the 
century — only 24 years .from now. Xigeria already lias an extremely 
high dependency ratio: about 45 percent of the population is under 
15 years of age. It is the most urbanized African country south of the 
Sahara, with 24 cities of 100,000 or more persons, and DO cities of 
20.000 or more. The capital. Lagos, with its excessive crowding, seem- 
ingly endless traffic jams, and evident pollution lias been called "urban- 
ization run amok." 

(T) 



1. The Xigeriax Government and Population Planning 

The Nigerian Government has been slow to recognize population 
problems and begin remedial programs. The country's second national 
development plan. 1970-74. called for: "Government to encourage the 
citizens to develop a balanced view of the opportunities for individual 
family planning on a voluntary basis." None of the actionable items 
specified in the second plan, however, were implemented : There was 
no integration of voluntary family planning services into the overall 
health care delivery system and no Federal support of family 
planning. 

The third development plan (1975-80) does not contain a popula- 
tion policy statement of any kind. Numerous statements and docu- 
ments of the Nigerian Government since the second plan indicate 
that its leaders do not consider Nigeria's population size and rate of 
growth any obstacle to development objectives. In fact, some govern- 
ment economic planners believe that Nigeria's land and resources can 
support a much larger population. The rate of growth is seen as man- 
ageable given the present rate of economic advance. 

Announced creation of a National Population Council in 1973 gave 
some hope to foreign observers, but the Council's membership and 
duties were not announced until May 1975. In July 1975, however, the 
Gowon Government was overthrown and the Council has yet to meet. 
Some Nigerians to whom we spoke believed that an initial Council 
meeting is possible in 1976. Given the present climate in Nigeria — both 
toward appointees of the former regime and toward population plan- 
ning — the future of the Council remains a question. 

Powerful pronatal forces are at work within Nigerian society. Be- 
yond the religious views of Moslems (47 percent) and a sizable Cath- 
olic minority, there are tribal rivalries among such major groups as 
the Hausa-Fulani, the Ybruba and the I bo. Tribal size is seen as im- 
portant to tribal power within the Nigerian federal system. States are 
established along tribal lines. 

Even arriving at accurate census figures is difficult. The 1963 census 
is generally held in disrepute, as is the 1973 census, because of manip- 
ulations resulting from tribal motives. The tendency Is accentuated 
because state -hares of federal revenues and representation in the fed- 
eral government are based on population size. 

2. Population Assistance to Nigeria 

A't hough Nigeria generally has been unwilling to use its own 
funds for family planning purposes, it has allowed commercial sales 
of cont raceptives and the operat ion of private family planning clinics 
including those of the I PPf affiliate, the Family Planning Council of 

Nigeria. It also has permit ted a variety of program- by foreign donors 
in t he populal ion area, as the following table show S : 



NIGERIA POPULATION PROGRAM ASSISTANCE, 1965-75 
[In thousands of dollars] 



: 


1965 


1966 


1967 


1968 


1969 


1970 


1971 


1972 


1973 


1974 


1975 


Total 


A. USAID title X bilateral assist- 


















830 

179 
552 

26 
456 

( 2 ) 

60 


225 

141 

778 

60 

( 2 ) 

4 

10 


560 

88 
637 
( 2 ) 
( 2 ) 

98 

80 


1,615 


B. Assistance by organizations re- 
ceiving AID title X support: 

UNFPA .- 

IPPF 

Pathfinder 

Population Council. 

FPI A 3 


C) 


(') 


C) 


0) 

""27" 
( 2 ) 


0) 
189 
( 2 ) 

322 


0) 
214 
( 2 > 

50 


0) 

419 

2 

224 


143 
699 

79 
273 

14 


692 
3,488 

194 
1,325 

116 


C. Assistance by other countries 
and organizations not receiv- 
ing AID title X support 




430 




164 


150 


120 


120 . 


1,134 


i Cumulative through 1971, $121,000. 

2 Not available. 

3 Family Planning International Associates. 

Source: USAID. 

























The UNFPA grants have largely been in the areas of demography 
and maternal and child health. IPPF aid has gone to its local affiliate 
for clinical and other related activities. Working primarily with uni- 
versity centers, the Population Council has sponsored demonstration 
family planning clinics and field research. The Pathfinder Fund has 
sponsored projects in sterilization and family planning information, 
and a population conference for medical students. 

3. U.S. Bilateral Aid : The Family Health Training Program 

In its assessment of the climate for family planning in Nigeria, AID 
realistically has determined that little can be done until the Federal 
Government takes steps to implement a population policy. For the next 
3 to 5 years an effective wide-scale family planning program appears 
out of the question in the absence of a policy change. 

The Nigerian Government has committed itself to an ambitious pro- 
gram of providing comprehensive health services to its people, both 
curative and preventive. The aim of the policy is to achieve a minimum 
coverage of 40 percent of the population by 1980, from the current 
estimated coverage of 25 percent. The following table shows the 1980 
targets : 

AVAILABILITY OF HEALTH MANPOWER AND FACILITIES IN NIGERIA 



1962 



1972 



1980 (Target) 



A. Health manpower: 

Doctor per population 1/40,000 

Dentist per population 1/931,000 

Registered midwife per population 1/7,800 

Registered nurse per population 1/7,600 

Community nurse per population 1/370,000 

Pharmacist per population ._ 1/93,000 

Medical Laboratory Technician per population 1/761,000 

'Radiographer per population 1/1,800,000 

B. Health establishments: 

Total 2,793 (21,986) 

Bed per population 1/2,455 

Teaching Hospitals.. 2(825) 

General Hospitals NA 

Health Centers NA 

Health Clinics NA 

Note: 2,793 (21,986) refers to 2,793 health establishments with 21,986 beds. 
Source: Third Development Plan. 



1/22,000 


1/14,000 


1/548,000 


1/400,000 


1/4,200 


1/3,000 


1/4,400 


1/3,000 


1/69,000 


1/40,000 


1/68,000 


1/40,000 


1/283,000 


1/100,000 


1/567,000 


1/100,000 


4,958 (42,698) 


10,000 (85,000) 


1/1,700 


1/1,000 


6 (2,798) 


18 (9,000) 


339 (25,307) 


450 (52,600) 


239 (1,310) 


1,650 (23,320) 


1,605 ( ) 


7,230 ( ) 



00-331- 



10 

Recognizing that family planning is most readily accepted in Africa 
when it is offered as a part of a broader program to improve the health 
of mother and child. AID/Lagos helped design a project which 
could (a) serve as a model for other integrated clinics, and (b) pro- 
vide a cadre of trained nurses from various states who could set up 
state MCH/family planning training centers. 

Called the Family Health Training Project, the AID-funded effort 
is to cost a total of Si. 8 million, of which $1.0 million already has 
been expended. It is the last on-going bilateral aid program which 
AID is conducting in Nigeria. (See pp. 55-56 on AID phaseout in 
Nigeria.) 

In April 1073 AID/Lagos made a grant to the Institute of Child 
Health. Lagos University Teaching Hospital, to develop at the insti- 
tute an institutional capacity to train nurses, midwives, and other 
health workers and to provide consulting and technical assistance 
services which will help improve and expand health education and 
care of mothers and children — especially those children under 5 
years — in nine areas of the Federation. 

At the core of the project is an intensive 16-week training course for 
nurses, midwives, and health auxiliaries, who are trained as a team 
in family health clinic concepts and then are placed at state family 
health clinics. Services offered, and thus the training the nurses re- 
ceive, includes: 

— Well- and sick-baby care ; 

— Nutrition education: 

— Innoculations and immunizations; 

— Prenatal and postnatal mother care; 

— General health and personal hygiene education : 

— Child spacing information and services; 

— Health counseling. 
Three mode] health clinics already have been opened: In Lagos, 
Sokoto (capital of a northwestern state), and Calabar (capital of ;i 
southeastern slate). Plans call for six more such -talc capital clinics. 
A member of the stall' study team visited the Lagos clinic, in the 
Shomolu section. Opened in August 1974. the clinic has a 50,000 target 
population. Wy October 197.") it had handled r>. :>!><> cases and registered 
5,000 children. The clinic was a crowded and active place with person- 
nel fully engaged in serving the health needs of mothers and children. 
The family planning component of the clinic appeared to he less 
successful. At the time of our idsit, only - J1 7 acceptors of family plan- 
ning had been recorded in 15 month-. Of those. 1 1 1 were on oral con- 
traceptives and L06 have had [UD's inserted. Since the entire U.S. 
contribution to the clinics come- from title X population funds, there 
is some question about the efficacy of the project as a family planning 
tm. 
One justification given was this: Should the Nigerian Government 
change its news on population activities, a vastly expanded health 
clinic system from 1,605 clinics in L972 to 7.l > ."'><) clinics (planned) in 
L980 could be an excellent means for delivering family planning 
servia I clinics will provide models for such activities, and the 



11 

training programs will produce personnel familiar with family plan- 
ning methods in a clinical setting. 

4. The Family Plaxxixg Council of Nigeria (FPCX) 

Of the 75 to 80 private family planning clinics in Nigeria, 52 are 
operated by the Family Planning Council of Nigeria, the local IPPF 
affiliate. In many cases those clinics are open only several hours 1 or 2 
days a week in state or local government-operated clinical facilities. 

The FPCN was characterized to ns as being "terribly ineffective^ 
in its attempts to be a substantial force in the private family planning 
sector. In July 1973, the IPPF sent a six-man inspection team to 
Nigeria. Its report included 68 recommendations for improvement, 
many of which do not yet seem to have been implemented. Among 
problem areas: 

(a) Finances. — Although FPCX has received support from several 
state governments in addition to its IPPF grant, it has been unsuc- 
cessful in getting any Federal aid. In addition, attempts to raise 
money from business firms and prominent individuals largely have 
been fruitless. FPCX recently reported that it does not intend to 
make any further approaches to the private sector. Another financial 
blow came recently when the Ford Foundation, which had provided 
past grants totaling $150,000, decided to terminate its support. 

(b) Administration. — Chief reason cited for the Ford Foundation 
action was poor administration, a problem mentioned frequently in 
connection with FPCX. Administrative costs in 1974 amounted to 
more than 45 percent of total expenditures, and the turnover in senior 
staff has been high. At the time of our visit, two cases reportedly were 
in Nigerian courts involving alleged corruption within the FPCN 
heirarchy. 

(c) Acceptors. — Poor management has affected clinical perform- 
ance, and the number of acceptors reported by the FPCX has not met 
expectations. In 1973, the IPPF criticized the' FPCX for the low num- 
ber of new acceptors. In its 1975 report, the IPPF did not provide any 
FPCX acceptor statistics but noted that: "FPCX is considering the 
possibility of divesting itself of responsibility for clinical services once 
state ministries of health and private hospitals are in a position to 
offer effective services themselves." This possibility seems remote given 
current apathy in official circles. 

(d) Tribal orientation. — From its inception, the FPCX has been 
dominated by Yorubas. Very little in the way of promotional ma- 
terials has been producd in languages other than English and Yoruba. 
As a result, the organization has lacked national standing and appeal. 
Although Yorubas sent to Hausa regions have met with little success, 
the FPCX has been slow to train indigenous personnel for such tasks. 

The IPPF in London seems aware of the numerous shortcomings of 
the FPCN. It was reported to us that early in 1974. a representative 
of IPPF approached another potential donor to the FPCN, warning 
against a grant to the organization because of suspected diversion of 
funds. Despite everything, however, the IPPF has continued to fund 
the program with increasingly large amounts of money. Actual ex- 



12 

penditures in 1974 were $716,000 with $641,000 projected for 1975. The 
announced budget for 1976 is $941,600— a $300,000 increase. 

5. Summary and Comment 

Nigeria is a country with serious problems of population growth. By 
the end of this century it well may have run out of petroleum reserves 
to exploit and yet be faced with double its present population. It could 
become the Bangladesh of Africa, if Nigerian leaders are not soon con- 
vinced of the need to provide family planning services along with the 
health care they desire for their people. 



D. GHANA 

Demographic Estimates 

Population (1974) (million) 10.0 

Density (persons per square mile) 105 

Birth rate (per 1,000 population) 1970-75 49 

Death rate (per 1,000 population) 1970-75 20 

Annual growth rate 1970-75 (percent) 3-3.3 

Infant mortality (per 1,000 live births) 160 

Life expectancy 43 

Years to double population based on 1970-75 rates 21 

Ghana is a country of 92,100 square miles — about the size of Indiana 
and Illinois combined — situated on the Gulf of Guinea on Africa's 
west coast, just north of the Equator. By African standards, Ghana 
has a diversified and beneficial economic base. It has natural resources, 
cheap power sources, agricultural exports (principally cocoa), and an 
industrial base more sophisticated than most of its neighbors. At the 
same time, the majority of the population is poor ($235 per capita 
GXP) and illiterate (75 percent). 

1. Ghana and Population Planning 

Of the six countries we visited, Ghana clearly has moved the farthest 
toward controlling its population growth. Unlike Nigeria, Ghana has 
adopted a population policy (1969) and a national family planning 
program (XFPP). The objective is to make family planning infor- 
mation and services available to all citizens, regardless of age. num- 
ber of children, or ability to pay. 

The long-term goal is to reduce annual population growth from an 
estimated 3.9 percent in 1970 to about 1.75 percent by the year 2000. 
For the midterm (1973-85), no significant decline is likely as the 
death rate is expected to decline faster than the birth rate. Initially 
the XFPP had expected to reach 1(1 percent of married women of 
child-bearing age of pregnancy by 1974. That would have been 200,000 
persons. There were, however, only -17.0(H) acceptors reported by 1974, 
or only 3 percent of such women. 

Although the goals of the Ghanaian population program have been 
widely lauded, implementation has faltered on political and bureau- 
cratic grounds. In January 1972, a political coup changed the country's 
leadership, and the new regime proceeded slowly in the area of popula- 
tion. Only since 1974 have activities returned to the prc-1972 pace. 

A principal obstacle to further progress are bureaucratic struggles 
over the implementation of the program. The XFPP is the responsi- 
bility of the Ministry of Economic Planning for planning, coordina- 
tion and funding. The implementing agency is the National Family 
Planning Secretariat headed by an executive director. The Ministry 
of Health (MOH). however, has major responsibilities for the service 
aspects of the program. Its personnel in hospitals, health centers, and 
health posts are counted on to provide family planning education and 
services. 

(13) 



14 

XFPP officials complain that the information and education com- 
ponents of their program have created a demand for services and sup- 
plies which is not being met I33- the current network of MOH clinics. 
Clinics offering family planning have grown from 138 in 197^ to 
196 in 1975. Of those. 45 percent are administered by the Ministry of 
Health. The ministry's rural health system is said "to be plagued by 
mismanagement and supply problems. 

As a result, officials of the XFPP to whom we spoke were interested 
in going outside the health system, with free-standing family plan- 
ning clinics, mobile units and commercial distribution systems. U.S. 
Mission population officials, on the other hand, believe that ultimate 
success lies in integrating family planning with health care. They have 
been trying — despite Ghanaian personality and institutional clashes — 
to get the two agencies to work together. 

The matter is complicated further by rivalries between the govern- 
ment units and the University of Ghana Medical School, which over- 
sees the Danfa project (see p. 17). Since the Danfa project seeks to 
create a "modeF on which the Ministry of Health clinic system can 
reform itself, the lack of cooperation thwarts the purpose of the 
enterprise. In addition, these institutional rivalries are accompanied 
by personal antipathies. 

2. Population Assistance to Ghana 

Unlike the Nigerian Government, the Government of Ghana has 
been willing to commit resources from its own budget to population 
planning programs. In fiscal 1976 the XFPP budget is $834,000, a 
significant increase over fiscal year 1975's $641,000. Ghana also has re- 
ceived significant population aid from foreign donors, of which the 
largest contributor has been the U.S. bilateral program, as shown in 
l he following table: 



15 



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16 

3. Direct AID Bilateral Programs 

The strategy of AID assistance is toward an integrated rural health/ 
family planning/nutrition program involving the XFPP. the Min- 
istry of Health and the Ministry of Economic Planning (nutrition 
sector). The current priority is toward strengthening and moderniz- 
ing the planning and management systems, to be followed by AID- 
supported programs encouraging an integrated delivery approach for 
bringing basic services to the rural population. 

This strategy is expressed through the following programs: 

(a) Population program support. — Direct AID assistance has been 
provided to the XFPP since fiscal year 1971 through June 1975 for a 
total contribution of $1,710,997. This support has provided for contra- 
ceptives, training opportunities, and other costs. In addition, during 
fiscal years 1971-73 the United States provided $641,737 for local cur- 
rency financing from Public Law-480, title I resources to allow the 
XFPP to initiate programs, train staff and otherwise begin motiva- 
tional efforts. Since 1974 these costs have become a part of the Govern- 
ment's budget. Future program efforts are directed at improvement 
of delivery services including some commercial contraceptive distribu- 
tion. ATI) assistance is planned for an additional 3 years, through 
fiscal year 1978, at which time major program support will be phased 
out, allowing for residual support for contraceptive supplies and U.S. 
specialized training. 

The following table shows past, present and anticipated expendi- 
tures under the program : 

AID ASSISTANCE TO NFPP POPULATION PROGRAM SUPPORT PROJECT 





Public 
Law 480, 

title 1 
local - 
currency 


Commodity support 
AID/W Mission Total Ni 


Participant 
training 


Other 
costs 




Fiscal years 


imber 


Value 


Total 


Actual: 
1971. . 


$79,838 . 

275,731 . 

286,168 . 




$213,873 
79, 874 
144,440 
127, 192 

132,026 
110,000 


$213,873 

79, 874 

144, 440 

533, 508 

444, 026 
171,000 

95,000 
584, 000 
390, 000 


8 
11 
11 
21 

10 
10 

3 

10 
6 


$39,000 . 
41,800 . 
70, 000 

64, 142 

32, 400 

65, 000 

16,000 . 
55, 000 
32, 000 




$332,711 


1972... 




""$5,666" 

4,778 

8,156 
100, 000 


397, 405 


1973. . 




505, 608 


1974. 

Estimated: 

1975 

1976 

Projected: 

I.Q 


$406, 316 

312,000 
61,000 

95,000 . 
474, 000 
290, 000 


602, 428 

484, 582 
336, 000 

111,000 


1977 

1978 




110,000 
100,000 


196, 000 
53,000 


835, 000 
475, 000 


Total 


641,737 


1,638,316 


1,017,405 


2,655,721 


90 


415,342 


366, 934 


4,079,734 



(h) Management of Rural Health S< rvices Project.- -AID also has 
in ilia led a program with the Mini.-t iv of] I call li thai aims a I strength- 
ening the capacity of the Minist it to provide Improved health, family 
planning and nut rit ion services in I he rural areas. I "ndcr conl rad wit h 
Kaiser Foundation International, assistance is directed at: (1) the 
establishment of an effective planning unit in the ministry; (2) re- 



17 

gional training in planning and management; and (3) assistance in 
formulating the health sector 5-year plan. Follow-on efforts are pro- 
posed to develop and implement a pilot low-cost integrated health 
family planning/nutrition delivery system to the rural areas. Total 
contribution to these projects is expected to reach $6.6 million in grants 
and $15 million in loans over the 5-year plan period. 

(c) Nutrition Improvement. — A joint Ministry of Economic Plan- 
ning (nutrition sector) /AID program has been proposed to: (1) de- 
velop a nutrition planning framework including a data base and nu- 
trition surveillance techniques; and (2) support several cost-effective 
nutrition projects in selected areas of rural Ghana. These 3-year train- 
ing, planning and pilot activities would integrate health and family 
planning components with a national nutrition effort. At the time 
of our visit this proposal was pending, awaiting release of the nutri- 
tion action plan scheduled for publication in January 1976. Total AID 
assistance is projected at $1.3 million over the first 3 years. 

4. The Daxfa Project 

The largest single AID-supported effort is in research through the 
Danfa project, operated by the University of Ghana Medical School 
with assistance from the University of California at Los Angeles 
(UCLA). A multiyear project, it is scheduled to end in February 
1979. AID contract costs are projected at $6.1 million, plus new cedis 
(Ntf) 536,000 in Public Law 480 local currencies. 

A member of the staff study team visited the project area, named 
after a village about 20 miles north of Accra. The project, now in its 
fifth year, is aimed at investigating rural Ghanaian communities in 
three research areas and developing models to help demonstrate cost- 
effective approaches to rural health and family planning. 

The Danfa project has been criticized as employing too complicated 
and intellectual an approach, as being too expensive, and as impossible 
to replicate on a national scale. Although these criticisms may to some 
degree be warranted, the project has provided some useful informa- 
tion on alternative methods of providing health and family planning 
services, data which not only have significance for Ghana but also 
for the rest of Africa. 

In the three study areas which have been established, three different 
sets of services are provided: Area Xo. 1 receives comprehensive 
health and family planning services; area No. 2 gets health educa- 
tion and family planning services but no health services; and area 
No. 3 gets family planning alone. The project has sought to answer 
the question : Is it worthwhile to integrate family planning with com- 
prehensive health services? From information gathered thus far. the 
answer appears to be "yes." 

Although all three areas are comparable in the numbers of new 
acceptors, continuation rates have been markedly higher in area Xo. 1 
where comprehensive health services are available. As a result, the 



BO- 33 1—76- 



18 

cost per participant month, including contraceptives, has been lower 
in area Xo. 1, as shown on the following table: 

[Figures in Ghanaian cedis] 1 

(Without 

A. Cost per new acceptor : contraceptives) 

Area No. 1 N*32. 18 

Area Xo. 2 N*31. 38 

Area No. 3 N*35. 07 

(Includes 

B. Cost per participant month : contraceptive*) 

Area No. 1 X<<3. 12 

Area Xo. 2 Nc4. 11 

Area Xo. 3 N*4. 52 

equals Xcl.14. 
Source: Danfa project. 



. Planned Parenthood Association of (than a 



Among the private organizations active in family planning in 
Ghana, to which the United States contributes, is the IPPF. Its af- 
filiate in the country, the Planned Parenthood Association of Ghana 
(PPAG), operates 34 clinics throughout Ghana and conducts train- 
ing and information/education programs. A member of the staff team 
visited its principal clinic in Accra — the Link Road Clinic. 

From a small beginning in 1967 that clinic now attracts an average 
of 250 family planning acceptors every month. Clinic records indicate 
that in 1974 there were a total of 2,961 acceptors recruited for a cumu- 
lative total of 9,732 in this one clinic. Unlike the IPPF affiliate in Ni- 
geria, the PPAG is highly regarded for its professionalism and com- 
petence. Private voluntary groups like PPA(J are emerging rtS im- 
portant agents in providing service, training, and public information. 
They account for oven- 50 percent of new acceptors recorded in Ghana 
during 1975. 

6. Sim. marv and Comment 

The All) Mission in Ghana considers an integrated approach to 
family planning to be the most acceptable and potentially successful. 
The inability of responsible agencies to work together has thwarted 
this strategy. Mission officials noted, however, that discussions in the 
l»,-i-t months have led them to heroine more optimistic since there ap- 
peal's to he a reemergence of enthusiasm and priority on t he part of the 
participating agencies, especially the Mini-try of Health, for a con- 
certed and integrated approach to family planning through a maternal 

and child healt h program. 

In its attempts to implement this approach, AIDmighl well attempt 
to use its financial Leverage with the Ministry to help achieve better 
cooperation with the N FPP. 



E. SIERRA LEONE 

Demographic Estimates 

Population (1974) (million) 2.8 

Density (persons per square mile) 93 

Birth rates (per 1.000 population). 1970-75 44. 7 

Death rates (per 1.000 population), 1970-75 20.7 

Annual growth rate. 1970-75 (percent) 2.41 

Infant mortality (per 1.000 live births) 136 

Life expectancy (years) 43.5 

Years to double population based on the 1970-75 rates 29 

Sierra Leone is a former British colony about the size of South 
Carolina which lies between Guinea and Liberia on the west coast 
of Africa. It has a poor, rurally based economy which has been rela- 
tively stagnant during the past several years. There are almost no 
funds in government coffers to pay for even basic services. Per capita 
annual income is $170. 

AID/AVashington considers Sierra Leone a country in which there 
has been quickening interest in family planning. That assessment is 
based in part on the country's 1975-80 five-year plan, which state- : 

To be effective, family planning programs must be well 
adapted to the social and cultural ways of life. The attitude 
of the people must be taken fully into account. In any case 
birth control facilities which are the basic operational com- 
ponents of any family planning programme cannot be forced 
on anybody. It is entirely up to the individual family to prac- 
tise birth control or not. While realizing the voluntary appeal 
of such a programme, it is equally clear that such facilities 
should be made available to anyone who. according to his or 
her own choice, wishes to make use of them * * *. 

The plan pledges 20,000 leones (about $18,000) for population ac- 
tivities during the plan period. The money could be spent for surveys 
and publications, seminars and training programs related to popu- 
lation topics, as well as for subsidies to nongovernmental family 
planning programs and organizations. The plan also recommended 
formation of a national population council which would help formu- 
late a population policy for Sierra Leone. 

Although the plan states that the 20,000 leones subsidy "is provided." 
not a single leone had been forthcoming at the time of our visit — near 
the end of the first year of the plan. U.S. Mission officials explained 
that the figure was not an actual appropriation or even a firm promise, 
because the plan lists only desired expenditures without matching them 
up with any realistic financing plan. Given the dire state of the na- 
tion's treasury and competing demands for fund.-, the Government is 
believed unlikely to meet even its very modest pledge. Nor are observ- 
ers sanguine about the chances for the formulation of a population 
policy in the near future. 

(19) 



20 

1. U.S. -Related Population Assistance 

Although the United States at present has no bilateral aid program 
in Sierra Leone, it has provided population-related training for four 
Sierra Leoneans, two at the Bureau of the Census, and two at the Me- 
harry Medical College Maternal and Child Health/Family Planning 
Center in Nashville, Tenn., at a cost of $34,182. According to U.S. 
officials, Sierra Leone has under consideration several projects in 
the population area which would require help from outside donors. 
One would involve technical assistance on fertility at the Government's 
MCH clinics. Another would provide family planning information 
and services through its agricultural cooperative system. 

_'. The Sierra Leoxe Family Planning Association (SLFPA) 

The local IPPF affiliate, founded in 1970, is the only operating 
family planning organization in Sierre Leone. It has eight clinics, 

with two more under construction. 

The Government permits the SLFPA to use space at existing health 
facilities in Government hospitals and clinics. It also is free to conduct 
mass information, education, and communications campaigns on fam- 
ily planning. The Government included a pledge of support to the 
SLFPA in its 5-year plan, and the group's officers hold a "promissory 
note*' from the Ministry of Development for 6,000 leones. The Min- 
is! ry of Finance, however, says no money is available, and SLFPA 
still has not received any funds. 

Principal support for the organization comes from the International 
Planned Parenthood Federation, which it joined in 1968. Expendi- 
tures for 1975 were estimated at $230,000, with a 1976 budget of 
$178,100. 

CARE has assisted the SLFPA by providing packages which con- 
tain milk powder, a high-protein food blend (CSM), folic acid and 
vitamin pills. Packages are distributed to women during their monthly 
\ i-it to the SLFPA main clinic in Freetown, the capital. An estimated 
t,500 packages are annually distributed to 1,500 families. 

We met with the president and guiding force behind the SLFPA, 
Dr. dune Hoist-lioness. She also is an obstetrician/gynocologist with 
a private practice. She noted that the SLFPA had steadily increased 
its clinic hours and that the number of new acceptors had grown by 
90 percent in 1974. Numbers practicing family planning, however, 
are only a fraction of eligible women. The SLFPA's 30 field workers 
averaged 20 new acceptors each per month in the cities, but only 10 
per month in rural areas where the majority of the population lives. 

Among pertinent comments made by Dr. I Iolst -Koness were the 

following : 

Infertility. She said much of her own efforts were directed at 

i real inir a, high degree of infer! ility among t lie women of Sierra Leone, 
a condition which creates considerable marital discord. Until prob- 
lems of infertility were solved, she said, people were unlikely to be 
interested in cont lolling excessive fert ility. 



21 

Opposition. — In her pioneering efforts, she continues to meet with 
official resistance. A priority objective, she said, is educating political 
leaders, including members of parliament and tribal chiefs to the need 
for family planning. 

Integrated approach. — Her own efforts have been to augment Gov- 
ernment health services. Only through an integrated family planning/ 
MCH approach, she said, could population planning effectively be 
brought to Sierra Leone. 

3. Summary and Comment 

A principal constraint on family planning programs appears to be 
unavailability of funds. If the United States reinstitutes a bilateral 
aid program in Sierra Leone, consideration should be given to includ- 
ing an integrated family planning component. 



F. IVORY COAST 

Demographic Est i mat < a 

Population (1974) (million) 4.7 

Density (persons i>er square mile) 44 

Birth rates (per 1,000 population) 1970-75 4.~>. 6 

Death rates i per 1.000 population) 1970-75 20.0 

Annual growth rate, 1970-7o (percent) 2. ."il 

Infant mortality (per 1.000 live births) 159 

Life expectancy (years) 43.5 

Years to double population based on 1970-75 rate 28 

The Republic of Ivory Coast is on the Gulf of Guinea, between 
Lil>eria and Ghana. A former French colony, it is slightly larger than 
New Mexico. The richest and most economically self-sufficient state in 
former French West Africa, its capital. Abidjan, is a modern com- 
mercial and population center. 

Because of its relative affluence, the Ivory Coast has attracted mi- 
grant workers from neighboring states. About 20 percent of its labor 
force is non-Ivorian. The largest group of immigrants, estimated at 
1.5 million, comes from Upper Volta. They are not permitted to 
become citizens and the Government has a policy that migrant work- 
ers ultimately should be replaced by Ivorians. 

1. Population Views of Government 

The Government of Ivory Coast does not favor family planning. It 
believes the country should increase its population to an optimum level 
of 8 million as soon as possible. It sees increased population as acces- 
sary to its national economic development. 

These attitudes may be buttressed by the Roman Catholic back- 
grounds of many high government officials, including the President, 
Felix Hbuphouet-Boigny. Although Catholics are only about 12.5 per- 
cent of the population, they occupy about half of government positions. 

Nevertheless, some changes have been occurring. Leading doctors 
openly advocate family planning and their views are reported in the 
press without Government discouragement. Some family planning 
services can be obtained at larger ( Jo\ eminent hospitals. Condoms and 
pills can be purchased over the counter. 

U.&. officials to whom we spoke do not believe that the Ivory Coast 
will be willing, in the foreseeable future, to undertake any official 

family planning act i\ it ies. 

(22) 



23 

2. Summary and Comment 

As shortsighted as the views of the Government seem to be, an active 
effort by the United States to convince leaders of Ivory Coast to aban- 
don their pronatalist policies are not likely to be productive. For the 
medium term, therefore, AID might seek to strengthen the country's 
health delivery systems if — as seems likely — increased amounts of bi- 
lateral U.S. aid are directed to that country. 

The United States, which has conducted a modest aid program in 
Ivory Coast through the years, granted the country's National Insti- 
tute of Public Health a total of $33,000 in fiscal year 1973 to study fac- 
tors affecting the Ivoirian child, working principally from existing 
studies and from maternal/child health clinics' records. Similar pro- 
grams may well be appropriate in the future. 



G. UPPER VOLTA 

Demographic EstimaU 8 

Population (1974) (million) 5.8 

Density (persons per square kilometer) '20 

Birth rate (per 1.000 population), 1970-75 48.5 

Death rate (per 1.000 population), 1970-7.") 25.8 

Annual growth rate, 1970-75 <i>ercent) 2. 27 

Infant mortality (per 1.000 live births) 182 

Life expectancy (years) 35 

rears to double population based on 1970-75 rate 30 

One of the poorest countries in Africa and the world. Upper Volta 
is landlocked in West Africa. Slightly larger than Colorado, it is 
bordered on the south by Ivory Coast, on the east by Niger, Ghana, 
Togo, and Benin, and on the north and west by Mali. 

A country which has felt the Sahelian drought most keenly. Upper 
Volta has a per capita annual income of $70. Some 68 percent of its 
national budget is foreign donated. Distributed on a per capita basis, 
annual government expenditures are $12. The literacy rate is estimated 
at 7 percent. One-half million Voltaics, or 60 percent of all males 
between 18 and 35, work outside the country. Their monetary returns 
are 17 percent of the gross national product. 

The position of the Government of Upper Volta is that its antici- 
pated population size, its present trends of population growth, and 
its fertility rates all are acceptable. Upon occasion the President. 
Maj. Gen. Sangoulc Lamizana, has expressed his government's feel- 
ings as being against family planning, but there has been no official 
discouragement at the level of private doctors. 

Currently no one outside of the urban well-to-do are being reached 
by family planning services. Costs are prohibitive. We were told that 
in Ouagadougou, the capital, doctors charge $3 per cycle of oral 
contraceptives, *7 for a. family planning visit, and $50 for a tubal 
ligation — amounts beyond the means of all but a very lew. 

Because of its high infant mortality rates and out migration. Upper 
Volta has not experienced population growth rates as high as it< 
neighbors. U.S. Officials believe this may be changing as successful 
immunization campaigns against smallpox and measles have reduced 
infant deaths. They fear- that burgeoning population growth rates will 
further retard economic progress. 

1. AJD'e "Population Auction A.genda" fob Upper Volta 

Id December 1974, All) prepared a population action agenda f<u- 
Upper Volta, which made these points: 

— The most important requirement is to change the government 

altitude toward birth control. 
— Because there arc virtually no health delivery systems and no 

trained family planning personnel in the country, a nonclinical 
approach should he used to obtain widespread coverage. 

(24) 



25 

— Efforts should be made to convince religious and other leaders 
outside government of the need for family planning and the 
widespread dissemination of contraceptive supplies. 

The plan also set three priorities for action : 

Priority No. 1. — AID would urge all organizations, donor countries, 
multilateral agencies, and private donors to help "broaden the outlook 
of * * * officials toward the population problem * * *." 

Priority No. 2. — Ask private family planning organizations to go 
to Upper Volta to see about setting up a private family planning 
clinic in Ouagadougou and other urban areas. 

Priority No. 3. — Continue to collect all available data on Upper 
Volta. 

Even these modest efforts seem to have been in vain. In fact, the 
only AID population activity in Upper Volta was canceled in April 
1975. It was a survey of vital statistics and disease being conducted by 
the U.S. Public Health Service's Center for Disease Control. It had 
been hoped that estimates of national population growth could be com- 
puted from the data. 1 

2. Two Projects Reviewed 

The study team reviewed two private population-related efforts dur- 
ing its brief stay in Upper Volta. 

First, we discussed with officials of the Societe Africaine d'Etudes et 
Development — (SAED) — their forthcoming film, to be funded prin- 
cipally with $21,280 from the Ambassador's self-help fund. The film, 
titled "Fates," will be a soft-sell effort at showing the economic dis- 
advantages of large families in an urban setting. Family planning will 
not be mentioned specifically. 

Second, we spoke with Mine. Jacqueline Tapsoba, who heads the 
Women's Association of Upper Volta. That organization has con- 
ducted child welfare programs for several years and has proposed to 
sponsor a Family Development and Welfare Center in which sex 
education and family planning information would play a part. To 
date, however, the association has not been able to engage sufficient 
outside donor support for the project. 

Both SAED officials and Mme. Topsoba expressed the belief that 
family planning would be acceptable to the Government and people 
of Upper Volta only if it were closely integrated with programs of 
health, nutrition, and child welfare. 

3. Summary and Commext 

Given the present unfavorable climate in Upper Volta for popula- 
tion-planning, AID's pursuit of a nonclinical approach and the dis- 
tribution of contraceptives is not likely to be fruitful. If AID is truly 
interested in bringing family planning to the country, it should con- 
sider an integrated approach. The Government wishes to enhance its 
health services and may be willing to accept a birth control component. 



1 The survey reportedly was canceled by AID/Washlngton because of limited popu- 
lation funds. The move was regrettable because not only did it upset arrangements 
made with the Peace Corps and the Government of Upper Volta, it also rendered useless 
much of the work which already had been completed. 



H. SENEGAL 

Demographic Estimates 

Population I 1074 | (million) 4.2 

Density (persons per square mile) 55 

Birth rate (per 1,000 population) 1969 45 

Death rate (per 1.000 population) 1909 21 

Annual growth rate. 197:5 (percent) 2.4 

Infant mortality (per 1.000 live births) 167 

Life expectancy (years) 37 

rears to double population based on 1973 rate 29 

Senegal, a country about the size of South Dakota, is located on 
the bulge of Africa. It has a long Atlantic coastline and is bounded 
by Mauritania. Mali, Guinea, and Guinea-Bissau. A Sahelian state, 
it is mostly rolling plains, with savanna-type vegetation. Its popula- 
tion is predominantly rural — 75 percent — and poor — per capita in- 
come $235 annually. Senegal is, however, one of the more industrially 
advanced states of former French West Africa, with natural resources 
and a good system of paved roads. 

The Government of Senegal has no policy favoring the develop- 
ment of family planning, either to reduce the rate of population 
growth or to improve maternal and child health. Its position has been 
one of disinterest. In 1 ( .)72 the government asked a Senegalese Family 
Planning Association to disband, but only after that group had experi- 
enced internal organization problems. 

According to observers, several constraints exist in Senegalese so- 
ciety which work against an active population policy. First, 80 per- 
cent of the population is Moslem, with traditional views on contracep- 
tion. Second, although Roman Catholics are a small minority, the 
powerful president of the country, Loopold-Sedar Senghor, is a de- 
vout Catholic. Finally, tribal rivalries affect notions of reducing 
birth rates. 

1. The Croix Blette Clinic 

We visited the only active family planning facility in Senegal, 
the Croix Hlene Clinic of Dakar, and spoke to its founder-director, 
Mrs. Whest-Allegre. Her private clinic, which provides family plan- 
ning aid as part of a general MCI I program, receives Support of 
$40,000 annually from the Pathfinder Foundation, an AID-supported 
organization. She fears, however, that these funds will be cut off or 
reduced if she is unable to obtain in-country support, private or public. 

Among points made by Mrs. A\ nest -Allegro, were these: 

— She has been gratified l>v favorable attention in the press and 
on government-owned television to talks which she has been 

giving on family planning. No attempts have been made to 

discourage her efforts, she said. 

(20) 



— Her periodic attempts at bringing mobile family planning 
services to other parts of Senegal have been almost too suc- 
cessful : The demand for services has overwhelmed the limited 
staff available for such ventures. 

— She believes that only in an integrated setting, linked with 
MCH services, will the Senegalese Government permit family 
planning to be offered. 

2. Senegal Rural Health Services Development Program 

AID has agreed to help the Government of Senegal develop a 
preventive medicine element within its general health program, and 
to extend services to rural areas. The Government plans to upgrade 
rural health services by making sure that all existing health posts are 
fully operational and by increasing coverage to 200,000 additional 
rural people annually. AID will contribute to the training and or- 
ganizational parts of the program. 

Estimated total cost of the AID contribution is $1.5 million, with 
funding scheduled to begin during the fifth — transitional — quarter at 
$325,000. Implementation of the project has been held up for some 
weeks, however, for lack of an American medical doctor with the ex- 
perience necessaiw to implement and manage the complex project that 
is envisaged. The problem arose after the doctor who had helped 
originate the project was killed in an auto accident. As we were leaving 
Senegal, word came that a qualified U.S. physician had been located 
for the job. 

Although the congressional presentation document states that 
through this project family planning services will be offered to the 
Senegalese, AID officials in Dakar denied any such intention. Some 
high Senegalese officials are said to be interested in providing family 
planning as part of health services, but still unwilling to take funds 
directly from the United States for that purpose because of possible 
adverse political reactions. 

3. Summary and Comment 

If, as it appears, there is awakening interest in Senegal to the need 
for family planning, the United States might best respond with a 
low-key approach. Its efforts within the health field in the country 
may well open up future opportunities. 



I. INTERNATIONAL PLANNED PARENTHOOD FEDERA- 
TION (IPPF) 

At the outset of the staff study, we visited the headquarters of the 
International Planned Parenthood Federation (IPPF) in London. 
Founded in 19r>2. the IPPF is the largest international voluntary, pri- 
vate organization in the population field. It is a federation of 84 na- 
tional family planning associations, with a central secretariat in Lon- 
don and a system of regional offices. 

The United States has been a major contributor to the IPPF since 
1068 and a substantial proportion of title X funds have been spent 
through that organization, as indicated by the following table: 

AID GRANTS TO IPPF 
[Showing percentage of AID grant to total I PPF income] 





AID grants 


Total income 






Amount 
(thousands) 


Percent 


1968. 


$2, 059 


$6,010 
8,813 
15,328 
20,512 
26,691 
36, 499 
41,005 
44, 093 


34.3 


1969.. 


3,826 


43.4 


1970 


5,338 


34.8 


1971 


6,242 


30.4 


1972 


9,598 


36.0 
33.8 


1973 


12,351 


1974 . .. 


13, 889 


33.9 


1975. 


11,889 


27.0 









Source: IPPF. 

The U.S. contribution to IPPF, which totals $65.2 million through 
1975, is both in cash and in contraceptive commodities. Until 1071, 
stance was provided the IPPF through grants for specific proj- 
ects. In thai year, however. All) arranged to provide general budget- 
ary support for the organization. The principle of a 40-percenl U.S. 
contribution in relation to the total income of the Federation was 
proposed, but has not always been met. 

A I I)"s support of IPPF is based on the belief that the organization 
has a unique ability to promote family planning. This results from 
the organization's private -tat us and experience. According to AID 
officials : 

— IPPF's private status <rivc S its program more 1 flexibility and 
more resistance to criticism than a Government program would 

have. 

— Since its family planning associations are Locally based, it Is 

able to promote family planning in countries which oppose 
foreign donor- in t he populat ion field. 
— IPPF has volunteers who influence legislation and other re- 
form- in their countries to remove obstacles to the promotion 
and pract ice of family planning. 



29 

AID officials defend the need for an institutional grant to aid IPPF, 
rather than project aid, by declaring that the former method permits 
the widest flexibility for the Federation. 

1. Criticism of IPPF Operations 

By granting its funds to IPPF, AID loses much control over their 
use. It does not participate in IPPF's programing nor does it audit 
the activities of the Federation's national family planning associa- 
tions. Instead it must evaluate performance on the basis of annual 
reports, audits at IPPF's central office in London and other internal 
AID information. 

Since 1973, a series of investigations by the General Accounting 
Office (GAO) and the Auditor General of AID, have turned up glar- 
ing weaknesses in the system. 

(a) GAO Report.— In a 1973 report entitled, "U.S. Grant Support 
to International Planned Parenthood Federations Needs Better Over- 
sight," the GAO found that : 

— The ability of IPPF's central office to implement effective pro- 
grams and to reasonably assure donors of program effectiveness 
was questionable. 

— Management review and control over family planning activities 
by family planning associations was uneven and weak. 

— AID and IPPF needed to provide greater assurance that the 
purposes of the AID grant were being achieved in an efficient 
and economical manner. 
The report took note of promises by IPPF to improve its personnel 
practices, programing, auditing and reporting. 

(b) Report of the Office of the Auditor General, 197 Jf. — The follow- 
ing year AID's own audit arm, the Office of the Auditor General, 
issued a report. In its summary of findings, it noted : 

— The audit showed that anticipated improvements in IPPF 
operations had not materialized. 

— Internal restrictions on the authority of the IPPF central office 
had resulted in a situation in which central officials lacked 
sufficient control over regional offices and national associations. 
"The condition must be changed to the extent needed to ensure 
AID that U.S. funds and resources donated have been properly 
used." 

— IPPF's evaluative capabilities were insufficient: "Although all 
five positions in an evaluation unit have been filled, only 15 
projects had been evaluated as of August 1, 1974, out of a total 
of over 152 projects." 

— The IPPF Annual Report to Donors was criticized as not 
statistically reliable. "Commodity deliveries, usage and inven- 
tory balances are inaccurate to the degree that significant un- 
explained quantities may have been lost or deviated from pro- 
gram purposes." 
On that occasion, the auditors recommended that AID review its 
budgetary support grant to the IPPF and determine whether the 
program might better be funded either by program grants directly to 



30 

the national family planning associations or by program grants to 
the TPPF. Apparently upon promises of improvement from the 
IPPF. AID did not alter its method of funding. 

(c) 1975 Auditor GeneraPs renew. — A subsequent review of the 
TPPF by AID auditors in 1975 found that little progress had been 
made on old problems and that new pertinent issues had arisen. Al- 
though an official report has not yet been issued, it is our understand- 
ing that the following additional problem- were raised by the 1075 
audit investigation : 

— At all levels of the IPPF system, loans have been made to em- 
ployees from project funds. Since AID does not have audit 
rights at the regional offices or within the family planning as- 
sociations, it is impossible to tell what or how much is involved. 
At IPPF London, however, loans totaling $96,475 were made 
to seven employees. None of the loans was authorized by the 
senior governing body. High-ranking officials received interest- 
free loans; lower ranking employees paid interest of from 7 to 
11 percent. 
— IPPF is involved in abortion-related activities, including dis- 
tribution of "menstrual regulation' kits. The auditors believe 
that under the current budgetary support grant to IPPF, such 
activities could be considered in violation of the Helms amend- 
ment which forbids use of U.S. funds for abortion activities. 
— There were significant problems of maintaining proper levels of 
supplies, including instances of massive oversupply and serious 
undersupply, as indicated by the following table: 







Used 




Number 










calendar 




of 


years 


1975 


1975 






year 


Inventory 


on- 


hand 


estimated 


projected 


FPA 


Product 


1974 


Dec. 31, 1974 


(4) 


-(3) 


usage 


deliveries 


(1) 


(2) 


(3) 


(4) 




(5) 


(6) 


(7) 


El Salvador.. 


. Orals 


52,316 


372, 201 




7.1 


216,928 





Granada 


do 


11,117 


49,633 




4.5 


12,000 


2,000 


Brazil.. 


do 


2, 493, 401 


212,123 




.1 


3, 600, 000 


4,001,800 


Honduras... 


do 


> 64, 638 


186, 354 




2.9 


90, 000 


100, 000 


St. Kitts 


do. 


i 6, 804 


45, 502 




6.7 


13,952 


20, 000 


St. Lucia 


. Condoms 


> 23, 184 


211,536 




9.1 


92, 160 


158,400 


Jamaica 


do 


2 148,320 


28, 368 




.2 


251,712 


223, 340 


El Salvador.. 


do 


•132,048 


357, 840 




2.7 


250, 000 


1,440,000 


Guatemala.. 


do 


75, 888 


666, 720 




8.8 


180, 000 


144,000 



> For 1975 projected deliveries to FPA exceed estimated usage. 
2 For 1975 projected deliveries are less than estimated usage. 

— The community based system (CBD) program for distributing 
contraceptives, which was begun in n>7! with U.S. encouragement 
and was to have been centrally administered, became the subject 
of mi [PPF policy change in 1975 which left the responsibility 
for management and report ing to t lie nat ional associat ions. 
Because of the many problems associated with [PPF management 
of its funds, auditors involved in the study have indicated their sup- 
port for- a return to program or 1 project funding, or other methods 
which would permit more specific accountability for the use of [J.S. 
assistance. 



31 

2. Discussions With IPPF Officials 

As a result of the several derogatory reports which had been re- 
ceived about IPPF operations, the staff survey team visited London 
at the beginning of the mission to discuss problems with IPPF offi- 
cials. We met with Julia Henderson, secretary general of the IPFF, 
and her deputy, Donald Lubin. Both are Americans. 

On the points raised above, they offered the following rejoinders: 

(1) The loans to IPPF personnel are designed as one element in the 
overall salary-benefit "package" to attract and keep highly qualified 
personnel. Except for a $9,400 loan to Ms. Henderson, the money was; 
used for house or flat purchases in London, where housing costs are 
high. 

(2) As for abortion-related activities, IPPF has a policy that contra- 
ception is the best defense against abortion. It has distributed about 
10.000 menstrual regulation kits, but has not found a demand for them 
within the national associations, and the abortion-related program is 
not being emphasized. 

(3) With regard to oversupplies of contraceptives, the IPPF officials 
indicated their suspicions that the auditors involved did not "under- 
stand the situation," especially the need to keep adequate supplies of 
contraceptives on hand in countries. 

(4) On the CBD program, it was suggested that in order to be suc- 
cessful, community distribution of contraceptives requires integration 
into the general family planning program of a national association. 
That could better be accomplished, it was explained, if management 
was left at the national, rather the international level. 

IPPF officials were strongly against the provision of AID 
funds on a program or project basis. They argued that such a system 
would: (a) Undermine IPPF's management system; (b) raise the 
American profile too high in IPPF affairs; (c) cause IPPF programs 
to be less acceptable in many countries; and (d) reduce IPPF's flexi- 
bility in programing for individual country needs. 

Both in Washington and London, we spoke to other persons fa- 
miliar with IPPF operations. The consensus was that because the orga- 
nization is a federation of national associations, it is virtually impos- 
sible to get centralized management and control. Member associations, 
which direct the IPPF through its governing body, do not want strong 
administration from London. Accustomed to a high degree of auton- 
omy, they want the funds that IPPF/London can provide, but not its 
direction. The CBD program, which was to have been centrally man- 
aged, foundered on that reality. 

3. IPPF ix West Africa 

The staff survey team had an opportunity to review IPPF opera- 
tions in three West African countries: Sierra Leone, Ghana, and Ni- 
geria. The organization has no affiliates in Senegal, Upper Volta. or 
Ivory Coast. 

In Sierra Leone, the national family planning association is clearly 
in the forefront of providing what minimal family planning services 



32 

are available. Although small, it appears to be effectively run and re- 
spected by the Government and the American community. (See p. 20.) 
La Ghana, the Planned Parenthood Association is acknowledged as 
perhaps the most effective agency in delivering family planning in- 
formation and services. (See p. 18.) 

In stark contrast to these successes, however, is the situation of the 
Family Planning Council of Nigeria, which has a budget twice as big 
as the Ghana affiliate and four times that of Sierra Leone. As noted 
earlier in this report (p. 11), the Nigeria association is plagued with 
internal problems. 

In our discussions with Ms. Henderson and Mr. Lubin, they were 
candid about the FPCN. describing it as a '"thorn". At the same time 
they expressed reluctance to require an extensive overhaul of the 
FPCX as a condition of future funding. A more effective program 
would emerge, they contended, if the Nigerians themselves revamp 
their program. In the meantime, IPPF has programed a $300,000 in- 
crease in the budget of the FPCN for 1976 — virtually all of it from 
external donors. 

4. Summary and Comment 

The ability of the IPPF effectively and efficiently to use family 
planning funds from the United States remains a serious question. Its 
willingness, indeed its ability, to require its affiliates to undertake ef- 
fective programs and rational fiscal management is weak. Moreover, 
the present structure of IPPF probably rules out any significant im- 
provement. Given these circumstances, it seems imprudent for the 
United States to continue to provide substantial assistance to IPPF in 
a way that prevents any effective oversight. Either title X funds 
should l>e provided to IPPF on a program basi>. as it once was. or 
other mechanisms should be employed to insure adequate accountabil- 
ity for IPPF*.- use of American foreign aid dollars. 



II. SENEGAL RIVER BASIN PROJECT 
A. SUMMARY OF FINDINGS 

1. Both the Executive and the Congress have pledged the 
assistance of the United States to the long-term development of 
the Sahel, the sub-Saharan West African region now recovering 
from a disastrous drought. 

2. The development of the water resources of the Sahel has 
become the priority objective of the Sahelian nations and of 
donor countries and organizations. Five major river and lake 
basin development projects are being considered. Funding would 
be through a "Sahel Development Investment Fund" which would 
put up to $5 billion into the region over the next 5 to 7 years. 
Congress may soon be asked to authorize up to $1 billion for the 
Fund. 

3. The Senegal River Basin Project, which would benefit Sene- 
gal, Mali and Mauritania, is the furthest advanced in planning. 
It will require the construction of two major dams, port and 
transportation facilities, and development of new perimeters for 
irrigated agriculture. The overall initial cost is estimated at $3.7 
billion. 

4. Although the United States has not committed itself to con- 
tribute to the project infrastructure, it plans bilateral expendi- 
tures of more than $36 million through fiscal 1977 to the tri- 
national organization which is planning the project. Most of the 
funds would go toward the development of an irrigated perimeter 
at Matam, Senegal. 

5. As a result of prior studies, our discussions with officials in 
the region, and our own experiences, a variety of questions have 
arisen about the wisdom of the long-term strategy for the Sahel 
in general, and the Senegal River Basin Project in particular. 

6. Our findings indicate that it would be premature for the 
United States to make a major pledge of funds either to the Sahel 
Development Investment Fund or to the Senegal River Basin Proj- 
ect until: 

a. There is considerably more specific information about the 
total cost, scope and impact of an overall Sahel development 
program which puts a dominant emphasis on the harnessing 
of river and lake waters in the region ; and 

(33) 



34 

b. There are clear and satisfactory answers to the several 
troublesome problems affecting the feasibility of the Senegal 
River Basin Project, including: 

Cost-benefit considerations, 

Sociocultural difficulties, 

Ecological and health hazards, 

Political differences among the three states, and 

Management deficiencies and lack of human resources. 

7. It is also suggested that alternate strategies of fulfilling the 
U.S. pledge to the long-term development of the Sahel be 
thoroughly explored. These might include an emphasis on dry 
land farming, rain water retention, drip irrigation, animal trac- 
tion and other more people-oriented techniques. 

8. To the extent that it is linked with the Senegal River Basin 
Project and to the overall development of the Sahel, the Matam 
irrigated perimeter project should not be undertaken by AID until 
the Congress has had an opportunity to review and act on the en- 
tire proposed commitment. 

The States of the Sahel 




B. The Problem of the Sahel 

During the Late L960's and the early 1970's, prolonged drought con- 
ditions gripped the Sahel region of Africa. Affected were some 23 mil- 
lion people in the nations of Senegal, Mauritania, Mali, Niger, Upper 
Vblta and ( 'had. As t he result of the Sahel drought : 

An estimated 100,000 persons died of starvation <>r related 
causes. 
— An additional 8.4 million underwent extreme hardships of hun- 
ger, nmlniit pit ion and disease, and loss of Livestock, crops, dwell- 
ings and Livelihood. 

Some 7 million cattle died at an estimated Loss of $288 million. 
Crops losses have been sel at more than $183 million. 



35 

The international community responded with considerable assistance 
during the crisis, as noted in the following table : 

Sahel Drought Relief Assistance, 1972-75 
Grants : 

U.S. Government $228, 200, 000 

U.S. voluntary agencies 15,600,000 

International community 163, 400, 000 

Total 407, 200, 000 

Loans : 

World Bank (IDA loans) 29,600,000 

World Bank (regular loans) 3,000,000 

Total 32, 600, 000 

Source : Agency for International Development. 

Moreover, the international donor community also rhetorically com- 
mitted itself to finance longer term development assistance to the six 
Sahelian countries, once the immediate crisis had passed. The United 
States, through the executive branch, pledged its participation. This 
decision was backed by the Congress when it passed the Foreign Assist- 
ance Act of 1973. That act contained the following provision : 

Sec. 639B. African- Saiiel Development Program. — The 
Congress supports the initiative of the United States Govern- 
ment in undertaking consultations and planning with the 
countries concerned, with other nations providing assistance, 
with the United Nations, and with other concerned inter- 
national and regional organizations, toward the development 
and support of a comprehensive long-term African Sahel 
development program. 

The drought itself ended in 1974 when sufficient rains fell, and the 
crop harvest was near normal. 1975 also was a good rainfall year. 

Nevertheless, five of the six Sahelian countries remain among the 
poorest and least developed in the world. They are Mali, Mauritania. 
Upper Volta, Niger, and Chad. Senegal is the exception, but it too is 
a less developed nation. 

As shown in the following table, growth rates of these countries 
lagged behind even before the drought crisis : 



36 



r-. p*> «3- o O ■ 

csi co in' in — ■' < 
I 



) OOO «T 0OCT> 

i in co cm' co cm' 



I I 



m cm 01 tt o r-~ 
o m' to' cm' i-* 



o c 1 ^- 



5 to 03 

O a> o 

?£ 2 » 

O "-a 

CS £^ 

^ — Q 



TO S 

55 ow 



S-E 



cm' cm cm' cm' cm cm' 



co lt> cm •*}• co lO 



MU)«T00«tO 



■a- *3- r- &> to «3- 

O CM ^-t' i" ,* ,_' 



cor-~ 
cmcm' 



cm it5cm ct> > 
ocm'co 



tt.z< 



■d._' ^ 5 <u a» 
oZXZrtS 



37 
C. Long-Term Development or the Sahel 

More than most countries, the economies of the Sahelian nations are 
dependent upon water. Their production is overwhelmingly rainfed. 
Rain is essential to the pasturage for grazing animals and to food 
crops. 

Planning for the region's long-term development has focused on 
water resources. This planning has been done by AID in concert with 
a number of other Western donor nations and international organiza- 
tions through the mechanism of the Club des Amis du Sahel. The 
Club, which also includes the Sahelian nations themselves, is given 
staff support by the Development Assistance Committee of the OECD 
in Paris. 

The plan involves the creation of an international institution called 
the "Sahel Development Investment Fund" (SDIF) which would 
pour as much as $5 billion into the Sahel over the next 5 to 7 years. 

The bulk of the funds would be directed at harnessing water re- 
sources by bringing up to 2.1 million acres of new land into irrigated 
farming along major rivers and lakes of the region. According to esti- 
mates, agricultural production could be increased as much as fourfold 
and the per capita income of the Sahel's population could be doubled. 

The principal water systems involved are five : 

1. The Senegal River Basin, which affects Mali, Mauritania 
and Senegal : 

2. The Niger River Basin, which affects Niger and Mali: 

3. The Volta River Basin, which affects Upper Volta : 

4. The Lake Chad Basin, which affects Chad and Xiger: and 

5. The Gambia River Basin, which affects the Gambia * and 
Senegal. 

The plan also includes a number of social goals, including raising 
the life expectancy of the people in the region, raising their literacy, 
doubling their food consumption and attaining an economic growth 
rate for the region of at least 5 percent annually. 

Any forecasts of the plan's achievements are highly speculative 
since no detailed statistics or economic development model has yet 
been developed. In late 1975, however, the Congress authorized $5 
million to help AID with planning costs connected with the develop- 
ment of its Sahel proposal. 

Further developments are likely as the Club des Amis du Sahel 
continues to meet to discuss the formation of the Sahel Development 
Iiwestment Fund. A meeting is set for Dakar, Senegal, in late March 
1976. 

Already, however, the proposal has been subject to considerable 
criticism on several grounds, including : 

Cost effectiveness. — A study of the Sahel by a group at the Massa- 
chusetts Institute of Technology - has noted that even though 
expensive water-control projects offer advantages, they cannot 

1 Although not usually considered a Sahelian nation, the Gamhia has been accepted as 
a member of CILSS (The Interstate Committee to Fight the Drought In the Sahel) by 
the other Sahelian nations. 

* "A Framework for Evaluating Long-Term Strategies for the Development of the Sahel : 
Vol. 1. Summary Report : Project Objectives. Methodologies, and Major Findings" by 
William W. Seifert and Nake M. Kamrany, Center for Policy Alternatives, Massachusetts 
Institute of Technology, Dec. 31, 1974. 



38 

alone make the region agriculturally self-sufficient because by the year 
2000. if current fertility rates continue, the region will be required to 
support a second 23 million people. Even if the endeavors prove to be 
as successful as their proponents suggest, the study says, they will not 
guarantee that the entire region moves forward in development. 

In an effort to demonstrate the co>t -effectiveness of the proposed 
Sahel development scheme. AID officials compare the project costs 
with the expense of potential future drought relief efforts. Their argu- 
ments are as follows: 

Throughout the lOOO's in the Sahel. there was a decline in 
food production and per capita income of 1.1 percent per 
year. 

At the same time, total foreign assistance to the Sahel aver- 
aged sl(52 million per year. 

In the drought years, especially 1972-4. total foreign assist- 
ance to the area was $900 million to $1 billion. 

Given steady or declining production rates, on the one hand, 
and increasing population and inflation rates, on the other, 
we estimate that a drought of the same magnitude in 1985 
would require $3 billion in relief. A drought in 1995-2000 
would require $6 billion in relief assistance. Deaths and dis- 
ruption in the area would be proportionately greater. Norma] 
year aid flows would have to increase to maintain the same 
real per capita effect. 

By contrast, we estimate that the $5 billion Sahel Devel- 
opment Investment Fund (SDIF) (1978-82) together with 
other assistance flows, will achieve as one of its goals the quad- 
rupling of food production in the area. As a consequence, we 
estimate that by 1992 the cumulative reduction in normal 
ongoing assistance flows to the area will equal the $5 billion 
SDIF figure. The Sahel, through its own efforts, will be pro- 
tected againsl the extreme results of past droughts, and 
normal year aid flows will continue to decline as the Sahelians 
are better able to produce or purchase what they require. 8 

Technological complexity. — The MIT study also suggests that the 
massive infusion of technologies, including elaborate techniques of 

water management, may not be appropriate, because the area does not 
have the required institutional infrastructure. Further, such tech- 
nologies tend to create secondary problems which can be overcome 
in developed countries, but can prove very serious in countries with 
xcvx limited resources. 



Memo to staff Btudy team. 



39 

Ecological fragility. — The ecological effects of large-scale water re- 
source projects can be unexpected and deleterious. The ecological bal- 
ance of the Sahel is extremely fragile and less is known about it than 
other regions. There is little margin for error. Ecological mistakes are 
at once more likely and more costly. 

AID officials have recognized the ecological difficulties involved and 
have acknowledged that further environmental studies are necessary. 
They also believe that it is possible to build the institutional infrastruc- 
ture along with the physical infrastructure involved in the Sahel 
development scheme. 

D. Congressional Action 

A provision of the International Development and Food Assistance 
Act of 1975, approved in December, reiterated congressional support 
for the formulation of a long-term comprehensive development pro- 
gram for the Sahel and other drought-stricken areas in Africa. 

The provision calls for (a) immediate planning to begin, (b) the 
authorization of $5 million for planning purposes, and (c) a require- 
ment on the executive branch to submit to the appropriate commit- 
tees by April 30, 1976, "a comprehensive proposal*' for Sahelian devel- 
opment including budget materials relating to proorams for fiscal 
1977. 

Because of the likelihood that the Committee on International Rela- 
tions, and perhaps the Congress as a whole, would be asked to take 
some action with respect to long-term development for the Sahel dur- 
ing 1976, the staff survey team included consideration of that subject 
among its objectives in West Africa. 

We met with the executive secretary of CILSS, the Sahelian states 




economic 

Development Service Office (REDSO) in Abidjan, Ivory Coast, to 
discuss the Sahel question. 

Our primary interest was in Senegal, for several reasons. First, of 
the five water resource projects potentially involved in the Sahelian 
scheme, the Senegal River Basin Project is the furthest in its plan- 
ning. Second, a number of irrigated perimeters, similar to those pro- 
jected for the region under the plan, already exist in Senegal. Third, 
the United States is already expending development assistance funds 
for projects related to Senegal River Basin development. 



40 
The Senegal River Basin 

R I T 



Saint. LOui 




Source : OMVS. 



In Senegal, we met with U.S. Embassy and AID officials; officials of 
SAEI), the Senegalese agency for the agricultural exploitation of the 
liver basin; and representatives of OMVS. OMVS stands for Or- 
ganization de Mise en Valeur du fleuve Senegal and is the trinational 

body (Senegal, Mali, Mauritania) responsible for the overall plan- 
ning of the river basin project. We also made a 3-day Held trip to 
St. Louis, where the OMVS Documentation Center and SAED head- 
quarters are located, and from there along the Senegal River to irri- 
gated perimeters at Lampsar, Ronkh, Richard Toll and Dagana. 

E. The Senegal River Basin Project 

After more than a decade of organization, planning and study, the 
three riparian countries of the Senegal River are about to begin the 



41 

development of the river basin. The plan will require an estimated $3.7 
billion of investment over a period of 35 years (1975-2010), concen- 
trated on the construction of dams, navigation and port facilities, 
inland transportation and the development of agro-industries and 
mining. 

The medium-term OMVS program (through 1985) includes four 
key project areas: 

1. The Manantali Dam to be constructed on the Bafin River, a prin- 
cipal tributary of the Senegal River, about 83 kilometers above the 
town of Bafoulabe in Mali. The dam will provide a minimum reg- 
ulated flow of 300 cubic meters per second in the Senegal River which 
is now subjected to alternating flood and dry periods. Major changes 
in the physical environment will occur downstream of the dam due 
to the regulated river flow and upstream due to the inundation of the 
upper valley. The Manantali Dam is also intended to provide a firm 
commitment of 100 megawatts of hydroelectric power. (Three other 
subsidary dams also are under consideration for Felou and Gouina in 
Mali and Gourbassi in Senegal, but their construction would be in a 
later phase. See map on p. 42 for locations.) 

2. The Diama Dam is to be constructed in the Senegal River Delta 
region and will be a smaller structure whose principal purposes are 
to prevent salt water intrusion into the lower Senegal River reaches 
and to provide fresh water for municipal and industrial water supply 
and irrigation systems. The dam will also accommodate year-round 
navigation. The area of inundation will be limited by a series of dikes 
and create a freshwater pool extending 400 kilometers upstream. 

3. An irrigated perimeter program has been initiated to increase 
the yield of agricultural crops. Approximately 128,000 hectares of 
existing postflood recession farming will eventually be replaced by 
over 400,000 hectares of irrigated perimeters. Sufficient water is antici- 
pated to allow double and triple cropping within the perimeters. 
During the medium-term period, development of 70,000 hectares is 
proposed, with subsequent development of 5,000 hectares each year 
thereafter. 

4. A river navigation system including a deepwater port at Saint 
Louis, a new entry channel, navigation locks at the Diama Dam, river 
channel improvements for over 900 kilometers and development of in- 
termediate ports of call have been proposed. The establishment of a 
minimum flow for year-round river navigation to the port of Kayes is 
an important factor, particularly to Mali and inland regions of 
Mauritania. 



42 



Senegal River Basin Project Infrastructure 




The financing for the Diama Dam seems virtually assured, with 
participation by the French aid agency (FAC) and the World Bank. 
The Manantali Dam funding was set back when the People's Repub- 
lic of China, after extensive engineering studies, pulled out — ap- 
parently because of the high costs involved. However, other pledges 
been received from Germany, Saudi Arabia, Kuwait and the 
African Development Bank. At the time of our visit in December 
1976, ( )MVS officials reported that of an estimated $365 million in first 
! million already had been raised. Moreover, it is likely 
I he SD1 F will com ribute to the project . 
To date t he I Fnited States lias not pledged to assist the Senegal River 
i Project. In the summer of 1975, however, AID's Africa Bureau 
proposed in a memo to Senator ( Mark of Iowa that if an addition.-! 
million was made available fortheSahel in fiscal 1976, the bulk of the 
funds would be used to conl ribute to three of the integrated river bavin 
mis planned for t he Sahelian area. Specifically : 
- io million for t he Senega] River Basin Project, including 

I million for irrigated perimeters and $20 $25 million for 
major in frastrud ure, including the Manantali Dam. 
s| million for planning and development of the Yolta River 
complex. 

million for studies of the developmental potential of Hie 
mbia River Vallej . 
OMVS officials were surprised to learn of this proposal since they 
had been told earlier bv AID's former Assistant Administrator I'm" 



43 

Africa that it was unlikely that the United States would contribute to 
Senegal River Basin Project infrastructure. 

F. United States Assistance to OMVS 

While awaiting the results of multidonor talks on long-range 
"transformation'' programs for the Sahel, the United States has sup- 
ported medium-term development projects through subregional or- 
ganizations like the OMVS. The assumption is that these organiza- 
tions would be the building blocks for a long-range development 
program. 

In a 1974 development assistance paper (DAP), AID's Africa 
Bureau contemplated that U.S. inputs to OMVS over a 5-year period 
might total $50 million. 

At the time of our visit to West Africa, however, OMVS-related 
AID projects, both those underway and planned, totaled $16.7 million. 
They included the following programs : 

1. Agronomic research {$960,000). — Implemented in fiscal 1975. the 
purpose of the project is to provide equipment, operating costs and 
technical assistance which will enable three OMVS research stations 
(Guede in Senegal, Kaedi in Mauritania and Same in Mali) to expand 
their activities and undertake applied research under field conditions 
at irrigated perimeters being developed in neighboring areas. A sub- 
project under this activity is an irrigated forage crop project which 
will involve all three research centers. 

2. Eric iron mental assessment (82.5 million) . — Implemented in fiscal 
1976, this project is for studies concerned with the potential impact 
of the proposed development of the Senegal River on such areas as 
human health, water quality and quantity, plant and animal life and 
sociocultural conditions. The project will extend over a 2-year period. 

?). Mat am perimeter study ($625.000). — Funds were provided to 
OMVS for the study of the feasibility of developing a 8,000 hectares 
perimeter for agricultural production near Matam in eastern Sene- 
gal. The study includes engineering, hydrological, economic, agro- 
nomic, topographic and sociological factors. To be carried out over 
an 8-month period, it was to be the basis of a decision by AID 
on whether to proceed with a loan to OMVS for the perimeter 
development. 

4. Organization management ($600,000). — This project would pro- 
vide a resident design team for a long-term training program operat- 
ing within the OMVS secretariat. 

5 Management and staff support (81.0 million). — This project 
would provide specialized training programs beginning in fiscal 1977 
for OM VS personnel in accord with recommendations obtained from 
the prior project. 

6. Multisector loan ($10 million).— Scheduled for implementation 
in fiscal 1977, the purpose of the loan would be to counteract some of 
the inequities which might otherwise arise in the distribution of bene- 
fits among the three member countries as development of the Senegal 
River Basin progresses. It is anticipated that the loan proceeds will 
be used, for the most part, to fund development activities in Mali and 
Mauritania. 



44 

Subsequent to the visit of the staff study team. AID determined — 
apparently on the basis of initial results from its 8-month study — ro 
fro ahead with the development of an irrigated perimeter on the 
Senegal River near Matam, with a commitment of funds in fiscal 
year 1976. 

The project will consist of the construction of a surface irrigation 
system to provide water for 10,000 hectares, of which 8.000 hectares 
(19,750 acres) will be tillable. The principal features of the project 
include the construction of upstream and downstream dams. 35 kilo- 
meters of dike. 5 pumping stations, main and secondary canals. 
drainage system, land leveling and service roads. Cost is set at > ; 20 
million. 

Main beneficiaries of the project will be 4.000 farm families — about 
35,000 neoplc — who will be tilling the 8.000 hectare area. AID esti- 
mates that their per capita income will increase from less than $1< 
over $180 annually when the project is complete. 

Thus, total planned commitments to OMVS by AID through fis -.d 
1077 are as follows : 

Summary of U.S. planned support to OMVS (fiscal 1975-17) 

Fiscal year IDT": OMVS agronomic research $000,000 

Fiscal year 107U : 

OMVS environmental assessment 2, ."00. 000 

OMVS Matam perimeter study 625,000 

OMVS Matam perimeter construction loan 20,000,000 

OMVS organization management (500.000 

Fiscal year 1077 : 

OMVS management and staff support 1. 0S0. 000 

OMVS multisector loan 10,000,000 

Total „ 3(5. 665, 000 

Although Vnc Matam irrigated perimeter reputedly is a viable proj- 
ect even without construction of the Manantali Dam. its full potential 
can only be realized after the dam is built. According to one AID 
official: "Production should be increased on this perimeter tenfold 
before the dam comes on stream and twenty fold thereafter.'' 

G. Assessment of the Project 

Because of the relal ively brief I ime which the sta (T study team could 
devote to a review of the Senegal River Basin Project — a massive and 
complex undertaking— definitive judgments on its value would be in- 
judicious. Our Investigations indicate, however, that significant ques- 
tions remain to be answered about this proposal for developing one 
subregion of the Sahel. 'These questions arise from several sources: 
— A si udv of the project done for AID by the Bureau of Reclama> 

t ion, Department of the Interior; 
— Misgivings about the proposed development of the Senegal 
River Basin apparent in our discussions with some AID officials, 
P.\. development personnel, and others; and 
— Our own observations of past and present efforts to develop 
irrigated perimeters along the Senegal River and subsidiary 
st reams. 



45 

It seems apparent that more needs to be known before a final judg- 
ment can be made about moving ahead with U.S. participation in the 
Senegal River Basin development scheme — particularly in the follow- 
ing areas: 

1. Economic and financial analysis. — As the Bureau of Reclamation 
study noted: ''Economic justification and financial feasibility can- 
not be determined from information presently available." Although 
AID has commissioned a study of the Matam perimeter, its scope does 
not include the entire matter of the Senegal River Basin proposal. 

Significanth T « AID computes the cost/effectiveness of the project 
against estimated costs of relief efforts which might be involved in 
subsequent droughts in the Sahel, rather than against alternative de- 
velopment strategies, including costs of investment in dry land farm- 
ing or rain water retention projects. The validity of such cost/effec- 
tive calculations is questionable. 

The creation of extensive irrigated perimeters is an expensive under- 
taking. Estimated costs are from approximately $5,000 per hectare for 
the first 4,000 hectares to about $3,500 per hectare average cost for the 
entire Matam perimeter. Some irrigated perimeters in the Sahel area 
have cost more. In order for such projects to be profitable, cash crops 
like rice and vegetables — rather than the traditional sorghum and 
millet — must be grown. 

AID itself has noted : 

The projected agricultural returns will also demand great 
strides in development of technological packages, extension 
and incentives to farmers. For example, the plan calls for 
going from 4 tons/hectare in rice production in 1980 to C> 
tons/hectare in the future. In fact few farms in the basin are 
presently producing as much as 2 tons/hectare. The results of 
4 tons or more achieved on research stations or special farms 
have not yet been repeated on a large scale. In sum, a tripling, 
rather than a 50 percent increase, in yields is required to meet 
plan targets. 4 

At present the agricultural policies of the Senegalese Government 
are not geared to encouraging farmers, but rather to keeping food 
prices low for city dwellers. There are few incentives to individual 
farmers to increase their investment in. or allocation of resources to, 
increased production. Furthermore. SAED. the Government's agricul- 
tural development agency for the river basin, has been a consistent 
money-loser on the 30.000 irrigated hectares which it already has devel- 
oped. Although SAED is said to be reevaluating its policies, it is diffi- 
cult to see a thorough-going reform without substantial changes in the 
attitudes of the Senegalese Government toward its agricultural sector. 

2. Sociocultural problems. — It appears that little, if any. attention 
has yet been given to the broad range of effects which the Senegal River 
development scheme is likely to have on the sociocultural systems of 
Senegal, and to a lessor degree, of Mali and Mauritania. This omis- 
sion may be critical because such effects are likely to bear on the ulti- 



4 Central-West Africa Region Development Assistance Pro: 



46 

mate success of the entire project. Among the obvious changes which 
the project will require are: 

— 20,^ 00 people will be displaced by the Manantali Dam and addi- 
tional numbers by the Diama Dam and the irrigated perimeter-. 
— Dry land farmers will be required to learn irrigated agriculture 

and the nurture of unfamiliar crops. 
— Farmers accustomed to annual cropping will be required to 
double and triple crop in order to make best use of the irrigated 
perimei 
Although some AID officials with whom we spoke emphasized the 
flexible nature of the Senegalese farmer, we saw evidence to the 
contrary. 

At several points near the Senegal River appeal- ghost towns which 
arc a mute testament to past sociocultural errors of SAED. In order 
to populate areas of past irrigated perimeters along the Senegal River. 
SAED built "company towns" and brought Avorkers from all parts 
of the country to till the fields. The experiment faded because 
of tribal rivalries and an unwillingness to work in unfamiliar 
surroundings. 

Today row upon row of empty houses stand in stark contrast to the 
successful cooperative 1 community of Ronkh nearby, where a truly in- 
digenous effort to develop irrigated agriculture has resulted in greater 
prosperity for villagers and a waiting list of families in the city who 
wish to return to the land. 

AID officials concede SAED's overpaternalism toward the farmers 
with whom it works, but see changes in the making for that organiza- 
tion. Our own daylong exposure to SAED officials leave us in doubt. 
3. Environmental and health prolyhin*. — Until the AID-sponsored 
environmental study is completed, there will continue to be large areas 
of ignorance about the environmental and health effects of the Senegal 
River Basin Project. For example: 

— The Diama Dam will not only stop salt water intrusion into the 
Senega] River, but also is likely to impede the fish which pro- 
vide an important source of protein to area people. 
— Development of the project as planned will increase the habitat 
of sector species and opportunities for contact of Mich dise 

malaria, schistosomiasis, onchocerciasis and trypanosomiasis. 
Thus far. little has been done to plan for combating the likely 
increased incidence of these diseases. 
— Irrigated perimeters make attractive habitats for millions of 
rats which have infested more than 180,000 acres in the Senegal 
River Basin area. Rat populations have exploded, apparently 
because their predators die* I in t he drought. Not only have t hey 
fed on and destroyed tons of grain, but their activities have 
undermined Large areas of earthen infrastructure in existing 
irrigated perimeters. (We met a German engineer who had 
recent ly developed an irrigated perimeter :>t Podoronthe Sene- 
gal River. Ami- mi absence of 1 month he returned to find 
the work l<> percent destroyed by the tunneling of rats.) Thus 
far, efforts to poison the rats have been largely unsu cessful. 
I. Political relations among OMVS *f<ii<s. Although OMVS is to 
represent the three basin states: Senegal, Mali and Mauritania, politi- 



47 

cal differences among the three sovereignties has impeded its organi- 
zational effectiveness. During our visit, representatives of the three 
countries were meeting in Nouakchott to iron out difficulties and ap- 
prove the strenthening of the position of the OMVS Secretary General. 

Indicative of the sensitivities involved is the $10 million AID multi- 
sector loan to OMVS planned for fiscal 11)77. It is to be apportioned 
among Mali and Mauritania — in the words of AID — "to counteract 
some of the inequities which may otherwise arise in the distribution of 
benefits among the three." In other words, if AID is to benefit Senegal 
by ^20 million for the development of the Matam irrigated perimeter, 
the other two countries must have something. 

5. Management and training. — A development scheme as complex 
as the Senegal River Basin Project will require administrators and 
trained technicians. Such expertise is in exceedingly short supply in 
the three OMVS countries. AID has programed $2.0 million for man- 
agement and staff support for OMVS, but training must be accele- 
rated at all levels. Our discussions with the Director of SAED indicate 
that his organization has no present plans for expanding executive 
training. 

Just as important is the training of the farmers and other workers 
to maximize the use of the water through the irrigation channels. 
According to observers, existing irrigated perimeters along the Sene- 
gal River are often operated at considerably less than maximum effi- 
ciency because water gates are allowed to remain open, excessive 
siltation is permitted to build up in irrigation channels, and dikes 
are allowed to crumble. There is little indication of adequate planning 
by OMVS or other involved agencies for the massive training job 
involved. 

H. COXCLUSIOX AXD COVOIEX'T 

The attraction of a large water resource scheme such as the Senegal 
River Basin Project is strong. Its proponents speak glowingly of 
"transformation" of the Sahelian subregion. It was. indeed, impres- 
sive to us to see "the deserts bloom" in the existing irrigated perim- 
eters along the Senegal River and its tributaries. But such prospects 
should not be so dazzling as to blind one to the hard realities involved. 
The Bureau of Reclamation's study of the Senegal River Basin Proj- 
ect notes : 

Unless considerable caution is exercised, a decision dynamic 
may be initiated in which the aspirations of the leaders of the 
three countries mesh with the needs of the various technical 
communities involved in preparing the reports, and with the 
values and goals of countries who might finance such an 
enterprise in such a way that a positive decision is made. 
Such a decision would meet the needs of everyone involved 
except the people and the cultures directly impacted by the 
project; those people, not the scientists and technicians, are 
the nexus of success or failure for the project. 

Experience counsels caution and restraint. Before World War II. 
the French financed a giant irrigation project using the waters of 
(he Niger River. Today only 45.000 of the planned 100,000 irrigated 
acres are being farmed. OMVS officials dismiss that model by labeling 



48 

it the product of colonialism. Yet their own plans, and those of SAED. 
betray a similar paternalistic spirit. 

Both in the Foreign Assistance Act of 1973 and the International 
Development and Food Act of 1975, the Congress emphasized giving 
foreign assistance to help solve the most pressing problems of poor 
people in poor countries in ways: (1) which maximized their own 
participation in the decision-making process and (2) which would 
result in relatively rapid improvement in their lives. As presently con- 
ceived, the Senegal River Basin Project, whatever its value, does not 
those standards. 

Tli is that, at the very least, alternate strategies of fulfilling 

the U.S. pledge to the long-term development of the Sahel should be 
thoroughly explored. These might include an emphasis on dry land 
farming, rain water retention, drip irrigation, animal traction, and 
other more people-oriented techniques. 

To date, not enough serious attention has been given to cost-benefit 
aspects of Sahel development. As pointed out before, the proposed 
water resource development schemes are very expensive. The popula- 
tions involved are relatively small. Additional exploration is required 
of ways to bring assistance to more people, sooner, and at less cost. 

Moreover, to the extent that the S20 million Matam irrigated pe- 
rimeter is predicated upon the accomplishment of the Senegal River 
Basin Project, including the construction of the Manantali Dam. and 
to the extent that the river project itself is part of long-term Sahelian 
development as envisioned under the SDIF. it should not be under- 
taken until the Congress has had an opportunity to review and act on 
the entire proposed commitment. This could be accomplished after the 
report on Sahel development from the executive branch which is re- 
quired to be submitted to the Congress by April 30, 1976. 



III. REIMBURSABLE DEVELOPMENT PROGRAMS 

IN NIGERIA 



A. SUMMARY OF FINDINGS 

1. Although estimates that the United States might obtain up 
to $6 billion in orders for reimbursable technical services from 
Nigeria appear grossly inflated, that country may provide op- 
portunities for sales of U.S. development-related expertise and 
training. 

2. Both United States and Nigerian officials believe that section 
681 of the Foreign Assistance Act ("Reimbursable Development 
Programs") will significantly facilitate the process of making 
such sales. 

3. Even if a multimillion dollar program of reimbursable tech- 
nical services ultimately is agreed upon, the U.S. AID Mission 
in Lagos should be closed out, as planned, and the program han- 
dled by a small staff of AID employees attached to the Economic/ 
Commercial Section of the Embassy. 

B. Background of Program 

Since 1961 agencies of the U.S. Government have been authorized, 
within the limits of the Foreign Assistance Act, to furnish services 
and commodities on an advance-of -funds or reimbursement basis to 
friendly countries, international organizations, and voluntary non- 
profit relief agencies. Through the years the Agency for International 
Development has used this authority, contained in section 607 of the 
act, to accomplish a number of useful projects, for which repayment 
subsequently was obtained. 

In 1974, the Congress, at the request of the executive branch, en- 
hanced this authority by passing a new provision, section 661 — Reim- 
bursable Development Programs. This section authorized the use of up 
to $1 million annually in fiscal year 1975 and 1976 for work with 
friendly countries to stimulate reimbursable aid programs. The target 
countries were those which were "graduates" of the U.S. development 
aid program or which otherwise were not receiving economic assist- 
ance from the United States. The provision linked such reimbursable 
aid with "facilitating open and fair access to natural resources of 
interest to the United States." 

Section 661 was further amended in 1975 by provisions of the Inter- 
national Development and Food Assistance Act of 1975 (Public Law 
94-161) to extend the program for 2 more years, to increase the avail - 

(49) 



50 

able funds to 82 million annually, and to liberalize somewhat the terms 
of repayment for recipient countries. 

The intended results of section 661, according to a State Depart- 
ment circular, are five : 

— To serve U.S. interests by promoting the political, economic 

and social development of non-All) developing countries; 
— To facilitate access by those countries, on a reimbursable basis. 

to U.S. technological services, public and private: 
— To promote American exports by providing technical services 
which might result in increasing demand for U.S. technology. 
hardware, and know-how ; 
— To help add to the U.S. knowledge base and strengthen the 
"worldwide network of arrangements for sharing and develop- 
ing technical know-how ;" and 
— To encourage Government and private agencies in developing 
their own resources for international technical cooperation. 
Tn practical terms, the provision permits AID to contract with 
foreign countries to send U.S. experts abroad, or to accept their na- 
tionals into the United States for training. The experts or the train- 
ing can be provided by (a) AID itself, (b) other agencies of the 
government, or (c) private firms and organizations, both profit and 
nonprofit. The funds available under the section are to be used to per- 
mit AID some resources in the planning phases of programs. 
The key word in such programs is "reimbursable." The recipient 

trnments must pay for the services which they receive. 
Although the legal authorities under section COT have been used 
successfully for some years, especially in Latin America, there has 
been little time to assess the impact of section 661, which first went 
into effect in December 1974. In testimony before the Committee 
on Internationa] Relations in July 1 ( .)7.">. the Deputy Director of AIR 
John E. Murphy, stated that the experience to that point had been 
"very promising." lie noted that with the expenditure of only about 
00 through the Department of Agriculture, the United States 
was able to enter into arrangements in Iran for some $125 million in 
servic 

On that occasion Mr. Murphy cited Nigeria as a potential customer, 
noting "the tremendous requirements of the Nigerians for which they 
are well able to pay." Because of the possible importance of reimburs- 
able development programs in future relations between the United 
States and Nigeria, the staff survey team was requested to review this 
activity during its mis-ion to Wesl Africa. 

( !. Nigeria as an AID "GraDi 

The largest country in Africa in terms of population and one of 
the more economically promising, Niareria has been a major recipient 
of I r.S. economic assi stance. From L962 to L974, Nigeria received a total 
of $434.8 million in CIS. aid. Ii has become a foreign aid "graduate" 
not because of the success of donor assistance but because of the escalat- 
ing return From its principal export pet roleum. A member of OPEC, 
Nigeria has benefited greatly from high petroleum pri e . [ts exports 
almost tripled in value to $9.8 billion in 1974 and were expected to go 



51 

even higher in 1975. Its foreign exchange reserves have been growing 
at a rate of about $400 million a month. 

Quite clearly Nigeria today is in a position to finance its own devel- 
opment. As a result U.S. assistance has been phased out. All on- 
going bilateral aid programs were given their final funding, a total of 
$6.8 million, in fiscal 1975. Last September the AID Mission staff in 
Lagos was reduced to nine: by next June there are to be only five. 

D. Nigerian Economic Planning 

The Nigerian economic picture is not an unclouded one : 

— Despite its new riches, Nigeria remains a heavily populated 
country with many desperately poor people (per capita income 
is $210 annually). It has a literacy rate of 25 percent and a life 
expectancy of 39 years. 
— At target rates of extraction, its petroleum reserves may be 
exhausted in 15 years or so. Within the past few months pro- 
duction has slumped by some 30 percent, cutting expected 
revenues. 
— There has been marked evidence of mismanagement and out- 
right corruption in handling these windfall profits. At one time 
more than 400 ships clogged the Lagos Harbor, bearing a vari- 
ety of goods, including millions of tons of cement. At one time 
Nigeria was paying more than $1.5 million daily in demurrage 
charges. With the present port capacity, it is expected to take 
from 24 to 36 months to unload just those ships now on line. 
By that time, much of the cement will be useless. 
Recognition of the need for more orderly and efficient economic 
planning has come from Nigerian Government economists and devel- 
opment specialists. We talked to officials of the Ministry of Economic 
Development and Reconstruction which developed Nigeria's third 
development plan (1975-80). Reflecting increased resources, the 
plan projects public sector investment of $32 billion, the bulk of it to 
be funded by Nigeria itself. Another $10 billion in investment would 
be added by the private sector. 

Public sector efforts will center on transport ($10 billion), heavy 
industry ($6 billion), agriculture ($3.5 billion), housing ($3 billion), 
communications ($2.5 billion), power ($1.5 billion), and health care 
($1 billion). Plans do not seem to have been seriously affected by the 
ouster of the Gowon government last year — but their implementation 
probably has been set back. 

The Nigerians have recognized that an acute constraint upon their 
ability to fulfill this plan is the lack of trained indigenous personnel 
to plan, implement and manage effectively an ambitious development 
program. On the subject of foreign expertise, the 5-year plan states: 

There is no doubt the Third Plan possesses a development 
potential which is unprecedented in the entire history of the 
nation. In order to achieve and sustain this level of economic 
activity, there will have to be a large influx of foreign techni- 
cal and specialized manpower, as a supplement to the na- 
tion's internal training efforts * * *. 



52 

Hitherto. Nigeria has tended to rely on technical assistance 
from friendly bilateral sources and multilateral international 
agencies. Efforts will continue to be made to secure required 
foreign experts through these sources * * *. 

However, the traditional concept of technical assistance as 
li i ree'' external aid will be reviewed, and appropriate changes 
in procedure for acquiring and utilizing such assistance intro- 
duced. A number of existing technical assistance agreements 
with foreign countries will be renegotiated with a view to 
ensuring the flow of technical personnel from cooperating 
foreign countries is not hampered by the supplier countries' 
budgetary limitations. This means, wherever necessary, execu- 
tive ministries and agencies of the Federal and State Gov- 
ernments will have to bear partially or wholly, the cost of 
expertise and training offers received from foreign countri* 

The plan authorizes all ministries and agencies, to the extent that 
traditional "free" technical assistance is not available from abroad, to 
employ required personnel wherever they are available at going rates 
of pay. 

E. Role of the United States 

For some time, the executive branch has sought a closer relationship, 
particularly in economic matters, with Nigeria. Nigeria supplies ap- 
proximately 20 percent of U.S. crude oil imports — about one-third of 
its exported production. During the Arab oil boycott of 1973-74, the 
continued flow of petroleum supplies from Nigeria to the United States 
proved particularly helpful. Political relations generally have been 
"proper' rather than close. Nigeria is fiercely devoted to its national 
independence. It has sharply disagreed with some U.S. policies, par- 
ticularly with regard to South Africa. Since the December visit of the 
staff survey team, relations have deteriorated over the issue of Angola. 
Nigeria has recognized the Soviet-backed MPLA as the legitimate 
government of Angola and has criticized U.S. efforts to obtain a coali- 
tion of all three rival forces. Matters have been further clouded by an 
abortive coup which saw the head of state killed. Blame has fallen on 
Western powers. 

In the past Secretary of State Kissinger has been eager to establish 
a United States-Nigerian "joint cooperation commission," similar to 
those which have been established wit h other count ries. Those commis- 
sions work to expand U.S. economic, scientific and cultural relations 
with a small number of selected countries which have a particular 
economic and political importance to the United States. Commissions 
have been established with several Socia . with India, and 

with key Middle Eastern countries. In 1974. for example, the United 
States established five joint commissions, with Saudi Arabia. Egypt, 
Jordan, Israel and Iran. In some cases those commissions have led to 
marked improvement in trade and investment opportunities. To date, 
however, the Nigerians have been unenthusiastic about a similar 
arrangement. 

Nigerian planning officials told us that they wish to be entirely 
to pick t he best expert ise in a given s< '-tor-, regardless of its source. The 



53 

idea of handing over major economic decisions to nationals of a single 
country, as some of the Francophone nations of Africa have done, is 

anathema to them. 

Such attitudes make it unlikely that the United States will come 
away with anything approaching a major share of Nigeria's purchase 
of technical services from abroad. Some officials in AID/TTashington 
have seen section 661 programs in Nigeria aggregating to as much as 
$6 billion over the next decade. U.S. officials in Lagos, including the 
Ambassador, believe such figures are grossly inflated. 

U.S. participation also is likely to be limited by the Nigerian policy 
of talking first to those countries which offer technical services pack- 
ages which combine concessional and reimbursable elements. At the 
time of our visit just such a package was in negotiation with the 
British. Since the U.S. concessional aid program in Nigeria is wrap- 
ping up, our officials are not able to make such offers. 

_ Despite these impediments, it seems clear that the Nigerians at the 
time of our visit were interested in buying a substantial amount of 
technical services from the United States. A sequence of events over 
the past several years indicates these prospects: 

1. THE BLOCK GRANT 

In 1971 the concept of a "block grant*' was introduced into the 
Nigerian aid program as a result of the country's increasing ability 
to do its own planning and set its own economic priorities, as well as its 
increasing sensitivity about the infringement of outsiders on decision- 
making processes in economic development matters. In essence, the 
block grant provided the Nigerian Government with a fund which 
would permit it to hire American technicians under direct contract, 
or through AID auspices, at its own discretion and in fields of its 
own choice. In addition, the Government could send participants to 
the United States or to other U.S. -sponsored institutions for voca- 
tional, academic, or technical training. 

Although the Nigerians were slow to begin using the block grant 
becar.se they had no existing administrative machinery to handle the 
details, they ultimately were pleased with the flexibility the grant 
provided and the speed with which their needs could be met. The 
initial block grant was for $2.5 million with an understanding that, 
if successful, it would be continued at about $1 million annually 
through fiscal 1976. 

When th^ decision was made to cut off concessional aid to Nigeria 
after fiscal 1975 the U.S. AID mission in Lagos feared hard feelings 
by the Nigerians if the block grant were abruptly ended. The Gov- 
ernment had established a special office to manage the program, and 
had on hand requests for services of U.S. experts and training worth 
nearly *4 million. Just before the end of fiscal 1975, therefore, AID 
gave a final grant of $2 million (for a total of $4.5 million), an in- 
crease of $1 million over the congressional presentational level. In the 
ensuing 5 months the entire amount has been fully programed. 

The decision to enhance the block grant seems to have been a wise 
one since it not only cushioned the blow of the aid cutoff, but also 
helped provide a bridge from free technical services to the purchase of 



services from the United States on a reimbursable basis. Through the 
block grant, the Nigerian Government has become acquainted with 
the extensive supply of highly skilled technicians in the United States, 
and has been introduced to American training facilities. According to 
the Mission, Mr. Ebong. the permanent secretary in the Economic 
Ministry, has expressed great interest in continuing the program with 
Nigerian funds once the AID contribution is exhausted. 

2. FACILITATE E SERVICES 

In recent months AID has provided a number of "facilitative serv- 
ices" to Nigeria which do not formally fall within the context of sec- 
tion 661. Among those services are: 

— Upon request, locating American technicians with special skills: 
— Placing groups of Nigerians in U.S. universities (e.g., 12 in 
petroleum engineering schools. 20 in public health institutions) ; 
■ — Arranging appointments and interviews for visiting Nigerian 
officials interested in hiring Americans or Nigerians residing in 
the United States: and 
- — Putting Nigerian officials in touch with American firms whose 
expertise and commodities are needed. 
One recent example of such activities resulted from the current port 
tieup. Asked to provide port operations experts, AID turned to the 
International Executive Service Corps i [ESC) which sent a team of 
experts to Lagos to review the situation. Although the group arrived 
in the immediate postcoup period and were unable to see all appro- 
priate officials, it did its fact-finding and issued a report to the Ni- 
gerian Government. 

[n another instance. AID Lagos received an urgent call from Ni- 
gerian officials asking for inflatable warehouse's to store a variety of 
items which had been shipped in by air to avoid the congested port. 
The airport's storage capacity was over-loaded. Goods had been 
dumped in the open air on the airport grounds. Although inflatable 
warehouses proved impractical. AID was able to put the Nigerians 
in tou<'h with an American firm specializing in prefabricated ware- 
house units. The company gained a si million contract for eight units 
which were built within a month. 

F. Reimbursable Development Programs 

Activities to date under section 661 — Reimbursable Development 

Programs are two: (1) Submission of a technical assistance package 
t<> \!D by Nigeria: ( -J ) further discussions with the ministries. 

l. THE TECHNICAL ASSISTANCE PACKAGE 

In December L974, the Nigerian Minist vy of Economic Development 

began assembling lists of the kinds of technical assistance it wished 
!o receive from each donor. The items included were taken from the 
Third Plan in consultation with functional ministries and states on 
their- priori! 

Apparently because concessional donors were given firs! crack 
at filling requests, the requesl to the United States for financing 



UNIVERSITY OF FLORIDA 




55 

services on a completely reimbursable basis was delayed by 5 months — 
until July 1975. 

When at last it came, the package was disappointingly small, par- 
ticularly for those in AID who have seen reimbursable development 
programs in Nigeria amounting to billions. The Nigerians proposed 
buying services from the United States amounting to 4.2 million 
naira (roughly $6.4 million) over the duration of the 5-year plan 
(1975-1980). The principal areas in which U.S. expertise or training 
was sought were education, agriculture, health, and general 
administration. 

The package has been transmitted to Washington where AID is 
identifying public and private institutions and organizations which 
may be interested and able to fill the requests. 

2. DISCUSSIONS WITH THE MINISTRIES 

The AID mission staff in Lagos has continued to approach the 
ministries of the Federal Government on possibilities for other reim- 
bursable technical services. The Minister of Economic Development 
and Reconstruction is reported to be enthusiastic about a program 
under section 661. He has given his approval for the United States 
to deal directly with the several states of Nigeria on reimbursable 
technical services. (U.S. officials believe that approaches to the states 
may prove fruitful since they have principal authority in agricul- 
ture and education, areas in which U.S. expertise and training are 
recognized as superior.) 

The staff survey team had an opportunity to discuss reimbursable 
development with officials of the development ministry and found 
them generally responsive to the mechanism provided by section 661. 
Without it. one official told us, the United States would have much 
greater difficulty in obtaining technical services contracts. 

In the weeks to come AID mission personnel expect to follow up 
their initial approaches to Nigerian officials for further discussions 
with individual functional ministries. 

Negotiations have moved the farthest with the Ministry of Agri- 
culture. Top officials there are interested in obtaining U.S. expertise 
for the development of large commercial farming enterprises. U.S. 
officials, on the other hand, have counseled increased support for small 
farmers consistent with the "New Directions" philosophy of the for- 
eign aid bill. If a final package of technical services is agreed upon, it 
probably will be a mix of commercial and small farm programs. 

To date, AID/Lagos has not called upon any of the planning funds 
provided under section 661. It is anticipated, however, that planning 
money may be needed to finance a team of U.S. agricultural experts 
who could work out details of a comprehensive program of technical 
services with the Nigerians. 

G. Staffing 

The notion has come from some quarters in AID that the Lagos 
Mission should not be closed completely in order to provide the insti- 
tutional backup for reimbursable development programs. AID/Wash- 



56 

ington lias not, however, wavered from its objective of terminating 
the Nigerian office. In testimony before the committee, Deputy Admin- 
;or Murphy suggested that reimbursable development activities 
would require that "we will probably have to station a few, a very 
limited number of people around the world in order to capitalize on 
the opportunities that we are able to identify/' He suggested that Ni- 
geria might be one of those site?. 

~ We believe that any such person should be attached to the Eco- 
nomic Commercial Section of the Embassy (which performs some 
similar functions) and that the AID Mission should continue to ter- 
minate its activities. To provide additional backup, it was suggested 
that AID make use of the skills and experience of the appropriate 
sector technical offices in the regional bureaus, other U.S. Government 
agencies, supported development institutions, and voluntary agencies. 
They could be used for identifying proposed personnel and training- 
resources requested by the Nigerians. 

In short, even a sizable U.S. program of reimbursable technical serv- 
ices in Nigeria could be handled by one or two AID employees at- 
tached to the Embassy, rather than" requiring perpetuation of a mis- 
sion presence. 

o